The DOI matches its Crossref record; 29 of the 30 references it cites were found in a registry or an index.
The effectiveness of the Austrian disease management programme for type 2 diabetes: a cluster-randomised controlled trial
Open accessAbstract
BACKGROUND: Disease management programmes (DMPs) are costly and impose additional work load on general practitioners (GPs). Data on their effectiveness are inconclusive. We therefore conducted a cluster-randomised controlled trial to evaluate the effectiveness of the Austrian DMP for diabetes mellitus type 2 on HbA1c and quality of care for adult patients in primary care. METHODS: All GPs of Salzburg-province were invited to participate. After cluster-randomisation by district, all patients with diabetes type 2 were recruited consecutively from 7-11/2007. The DMP, consisting mainly of physician and patient education, standardised documentation and agreement on therapeutic goals, was implemented in the intervention group while the control group received usual care. We aimed to show superiority of the intervention regarding metabolic control and process quality. The primary outcome measure was a change in HbA1c after one year. Secondary outcomes were days in the hospital, blood pressure, lipids, body mass index (BMI), enrolment in patient education and regular guideline-adherent examination. Blinding was not possible. RESULTS: 92 physicians recruited 1489 patients (649 intervention, 840 control). After 401 ± 47 days, 590 intervention-patients and 754 controls had complete data. In the intention to treat analysis (ITT) of all 1489 patients, HbA1c decreased 0.41% in the intervention group and 0.28% in controls. The difference of -0.13% (95% CI -0.24; -0.02) was significant at p = 0.026. Significance was lost in mixed models adjusted for baseline value and cluster-effects (adjusted mean difference -0.03 (95% CI -0.15; 0.09, p = 0.607). Of the secondary outcome measures, BMI and cholesterol were significantly reduced in the intervention group compared to controls in ITT after adjustments (-0.53 kg/m²; 95% CI -1.03;-0.02; p = 0.014 and -0.10 mmol/l; 95% CI -0.21; -0.003; p = 0.043). Additionally, more patients received patient education (49.5% vs. 20.1%, p < 0.0001), eye- (71.0% vs. 51.2%, p < 0.0001), foot examinations (73.8% vs. 45.1%, p < 0.0001), and regular HbA1c checks (44.1% vs. 36.0%, p < 0.01) in the intervention group. CONCLUSION: The Austrian DMP implemented by statutory health insurance improves process quality and enhances weight reduction, but does not significantly improve metabolic control for patients with type 2 diabetes mellitus. Whether the small benefit seen in secondary outcome measures leads to better patient outcomes, remains unclear. TRIAL REGISTRATION: Current Controlled trials Ltd., ISRCTN27414162.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Figures
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1047 · Cited by 15,297 · cited 1×
“Background The prevalence of type 2 diabetes is rising worldwide for all age groups due to population growth, ageing, urbanisation, increasing prevalence of obesity and physical inactivity [1,2].”
10-year follow-up of intensive glucose control in type 2 diabetes
Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., & Neil, H. A. W. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0806470 · Cited by 7,751 · cited 1×
“However, the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that even small differences in HbA1c may translate into benefits regarding acute and chronic diabetic complications as well as hospital admissions in the long run [30].”
Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections
King, H. O. M., Aubert, R. E., & Herman, W. H. (1998) · Diabetes Care · doi:10.2337/diacare.21.9.1414 · Cited by 6,294 · cited 1×
“Background The prevalence of type 2 diabetes is rising worldwide for all age groups due to population growth, ageing, urbanisation, increasing prevalence of obesity and physical inactivity [1,2].”
Consort 2010 statement: extension to cluster randomised trials
Campbell, M. K., Piaggio, G., Elbourne, D. R., Altman, D. G., & for the CONSORT Group (2012) · BMJ · doi:10.1136/bmj.e5661 · Cited by 3,510
Improving Primary Care for Patients With Chronic Illness
Bodenheimer, T. (2002) · JAMA · doi:10.1001/jama.288.14.1775 · Cited by 2,961 · cited 1×
“The chronic care model (CCM) has been developed to improve the care for patients with chronic conditions like diabetes mellitus type 2 [6].”
CONSORT statement: extension to cluster randomised trials
Campbell, M. K., Elbourne, D. R., & Altman, D. G. (2004) · BMJ · doi:10.1136/bmj.328.7441.702 · Cited by 2,557 · cited 1×
“Details of the flow of clusters, physicians and patients through the study are shown in figure 1 as suggested by the consort statement for cluster randomised trials [17].”
Improving the reporting of pragmatic trials: An extension of the CONSORT statement
Zwarenstein, M., Treweek, S., Gagnier, J. J., Altman, D. G., Tunis, S., Haynes, B., Oxman, A. D., Moher, D., & groups, F. T. C. A. P. T. I. H. (. (2008) · BMJ · doi:10.1136/bmj.a2390 · Cited by 1,813 · cited 1×
“According to the extension of the CONSORT statement for pragmatic trials, special emphasis should be put on the generalisability (external validity) of the results [27]: Our trial is characterised by a high level of internal validity.”
Design and Analysis of Cluster Randomization Trials in Health Research
DONNER, A. P., & Klar, N. S. (2000) · Cited by 1,236
Criteria for evaluating evidence on public health interventions
Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002) · Journal of Epidemiology and Community Health · doi:10.1136/jech.56.2.119 · Cited by 1,042 · cited 1×
“Randomised controlled trials have been described as the best method for appraising a causal relationship between a complex intervention and clinical outcomes [12].”
Weingarten, S. R. (2002) · BMJ · doi:10.1136/bmj.325.7370.925 · Cited by 735 · cited 2×
“One showed that overall DMPs have positive pooled effect sizes regarding improvement in care [21].”
Are randomized clinical trials good for us (in the short term)? Evidence for a “trial effect”
Braunholtz, D., Edwards, S., & Lilford, R. J. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00305-x · Cited by 539 · cited 1×
“study itself may have an effect on physician performance and patient compliance [25].”
The effectiveness of disease and case management for people with diabetesA systematic review
Norris, S. L., Nichols, P., Caspersen, C. J., Glasgow, R. E., Engelgau, M. M., Jack, L., Isham, G. J., SNYDER, S., Carande-Kulis, V. G., & GARFIELD, S. A. (2002) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(02)00423-3 · Cited by 495 · cited 2×
“The results of the fourth review are even less convincing due to the inclusion of all study types and settings (non-controlled observational studies as well as studies performed in HMOs [Health Maintenance Organisations] and Community Clinics) [24].”
A meta-analysis of interventions to improve care for chronic illnesses.
Tsai, A. C., Morton, S. C., Mangione, C. M., & Keeler, E. B. (2005) · PubMed · Cited by 482
Assessing the impact of complications on the costs of Type II diabetes
Williams, R., Gaal, L. V., & Lucioni, C. (2002) · Diabetologia · doi:10.1007/s00125-002-0859-9 · Cited by 352 · cited 1×
“The prevalence of late diabetic complications corresponds to the European average as depicted in the CODE-2-study [4].”
Randomised controlled trial of structured personal care of type 2 diabetes mellitus
Olivarius, N. D. F., Beck-Nielsen, H., Andreasen, A., Hørder, M., & Pedersen, P. A. (2001) · British medical journal · doi:10.1136/bmj.323.7319.970 · Cited by 323 · cited 2×
“The negative six-year-study from Denmark mentioned above does not have sufficient power to demonstrate any benefits regarding outcome or mortality [11].”
Ofman, J. J., Badamgarav, E., Henning, J. M., Knight, K. K., Gano, A. D., Levan, R. K., Gur-Arie, S., Richards, M. S., Hasselblad, V., & Weingarten, S. R. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2004.03.018 · Cited by 291 · cited 2×
“The most recent review presented similar results with only 24 out of 66 experimental or quasi-experimental trials on the effectiveness of DMPs showing significant improvement in patient care [22].”
Evidence for the effect of disease management: is $1 billion a year a good investment?
Mattke, S., Seid, M., & Ma, S. (2007) · PubMed · Cited by 216
Advanced Statistics:Statistical Methods for Analyzing Cluster and Cluster-randomized Data
Wears, R. L. (2002) · Academic Emergency Medicine · doi:10.1197/aemj.9.4.330 · Cited by 206 · cited 1×
“We calculated intra-cluster correlation coefficients (ICC) for both levels of clustering (table 5) [18-20], and then used mixed models to adjust for cluster effects and baseline value.”
A systematic review of diabetes disease management programs.
Knight, K. K., Badamgarav, E., Henning, J. M., Hasselblad, V., Gano, A. D., Ofman, J. J., & Weingarten, S. R. (2005) · PubMed · Cited by 189
Are distinctive ethical principles required for cluster randomized controlled trials?
Hutton, J. L. (2001) · Statistics in Medicine · doi:10.1002/1097-0258(20010215)20:3 · Cited by 125
and the ENDIT Screening Group, Williams, A. J. K., Bingley, P. J., Moore, W. P. T., & Gale, E. (2002) · Diabetologia · doi:10.1007/s00125-001-0749-6 · Cited by 79
Is there a survival benefit within a German primary care-based disease management program?
Miksch, A., Laux, G., Ose, D. J., Joos, S., Campbell, S., Riens, B., & Szécsényi, J. (2010) · PubMed · Cited by 73
Dorner, T. E., Rathmanner, T., Lechleitner, M., Schlögel, R., Roden, M., Lawrence, K., Schwarz, F., Kiefer, I., Kunze, M., & Rieder, A. (2006) · Wiener klinische Wochenschrift · doi:10.1007/s00508-006-0666-2 · Cited by 30 · cited 1×
“5 to 3%) is lower than the Austrian average [3].”
Generalizing disease management program results: how to get from here to there.
Linden, A., Adams, J., & Roberts, N. E. (2004) · PubMed · Cited by 18
Sönnichsen, A. C., Rinnerberger, A., Url, M. G., Winkler, H., Kowatsch, P., Klima, G., Fürthauer, B., & Weitgasser, R. (2008) · Trials · doi:10.1186/1745-6215-9-38 · Cited by 11 · cited 1×
“Further details of the methodology and study protocol have been published elsewhere [ 16 ].”
MethodSelf-citation[Evaluation of disease management programs--current deficits, demands and methods].
Gerlach, F. M., Beyer, M., Szécsényi, J., & Raspe, H. H. (2003) · PubMed · Cited by 10
Ivo Rakovac, A., Plank, J., Jeitler, K., Beck, P., Seereiner, S., Mrak, P., Bauer, B., & Pieber, T. R. (2009) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-009-0659-7 · Cited by 10 · cited 2×
“In Austria, deficits in implementation of standard care for type 2 diabetes exist, and there appears to be a strong demand for management optimisation [ 5 ].”
BackgroundResultZur Frage der kombinierten Behandlung von Hautkarzinomen
Fabry, J. (1914) · Archives of Dermatological Research · doi:10.1007/bf02126842 · Cited by 4
Structured treatment of diabetes in the country
Ecker, J., Witzmann, G., Gmeiner, H., Aigner, I., & Said, H. (2005) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-005-0197-x · Cited by 4 · cited 1×
“This programme, too, has not been evaluated in a randomised controlled trial, and has been restricted to small samples of highly motivated physicians [10].”
Diabetes mellitus – Leitlinien für die Praxis
(2007) · Wiener klinische Wochenschrift · doi:10.1007/s00508-007-0832-1 · Cited by 4
Research works printed but not linked: 3
- Berger M, Grüßer M: Behandlungs- und Schulungsprogramm fürTyp 2 Diabetiker, die nicht Insulin spritzen. Deutscher Ärzteverlag, Köln. 1997
- Weitgasser R, Aistleitner M, König C, Rakovac I, Habacher W: Diabetesschulung "Neu" für Patienten mit Typ-2-Diabetes im Land Salzburg. Diabetes, Stoffwechsel und Herz. 2009, 18: 25-27.
- Österreichische Diabetes Gesellschaft: [Diabetes mellitus--guidelines for general practice. Revised and expanded 2007 edition]. Wien Klin Wochenschr. 2007, 119: 5-64.
Cited by
Sorted by citations
Rieckert, A., Reeves, D., Altiner, A., Drewelow, E., Esmail, A., Flamm, M., Hann, M., Johansson, T., Klaaßen‐Mielke, R., Kunnamo, I., et al. (2020) · BMJ · doi:10.1136/bmj.m1822 · Cited by 148
“We powered the study to detect a relative risk reduction of 20% in the decision support group at 80% power and an α level of 5%, assuming an intracluster correlation coefficient of 0.01 (based on an earlier cluster trial 32 ) and a 10% attrition rate in both patients and practices.”
MethodInfluentialSelf-citationOvercoming fragmentation in health care: chronic care in Austria, Germany and the Netherlands
Nolte, E., Knai, C., Hofmarcher, M. M., Conklin, A., Erler, A., Elissen, A., Flamm, M., Fullerton, B., Sönnichsen, A. C., & Vrijhoef, H. J. (2012) · Health Economics Policy and Law · doi:10.1017/s1744133111000338 · Cited by 139
“The evidence was mixed, however, with non-significant improvements in metabolic control, the main clinical outcome, although other measures (weight and cholesterol) improved significantly (Sönnichsen et al., 2010).”
ResultSelf-citationPatient-mediated interventions to improve professional practice
Fønhus, M. S., Dalsbø, T. K., Johansen, M., Fretheim, A., Skirbekk, H., & Flottorp, S. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012472.pub2 · Cited by 107
Sönnichsen, A. C., Trampisch, U. S., Rieckert, A., Piccoliori, G., Vögele, A., Flamm, M., Johansson, T., Esmail, A., Reeves, D., Löffler, C., et al. (2016) · Trials · doi:10.1186/s13063-016-1177-8 · Cited by 108
“01 (derived from an earlier cluster-randomized trial involving GP practices as clusters [45]).”
BackgroundSelf-citationInterventions to increase attendance for diabetic retinopathy screening
Lawrenson, J. G., Graham-Rowe, E., Lorencatto, F., Burr, J. M., Bunce, C., Francis, J., Aluko, P., Rice, S. J. C., Vale, L. D., Pető, T., et al. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012054.pub2 · Cited by 94
Metadata
- Authors
- Sönnichsen, A. C., Winkler, H., Flamm, M., Panisch, S., Kowatsch, P., Klima, G., Fürthauer, B., & Weitgasser, R.
- Affiliations
- Paracelsus Medical University (AT)
- Private Pädagogische Hochschule Augustinum (AT)
- Corresponding author
- Sönnichsen, Andreas C
- Venue
- BMC Family Practice
- Published
- 2010-11-05
- Volume
- 11
- Issue
- 1
- Pages
- 86-86
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC2989935
- OpenAlex
- W2057504267
- Cited by
- 141
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 13 · 2022: 4 · 2021: 2 · 2020: 5 · 2019: 1 · 2018: 6 · 2017: 2 · 2016: 3 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 41
- FWCI
- 22.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Universität Heidelberg
- Paracelsus Medizinische Privatuniversität
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- type 2 diabetes, disease management programs, primary care, HbA1c, glycemic control, quality of care, patient education, physician training, treatment goals, body mass index, cholesterol, hospitalization, guideline adherence, cost-effectiveness, general practitioners, diabetes self-management education
- MeSH terms
- Adult, Austria, Diabetes Mellitus, Type 2, Female, Health Plan Implementation, Glycated Hemoglobin, Humans, Male, Program Development, Disease Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
