RESUMEN
BACKGROUND: Staged Diabetes Management (SDM) improves glycaemic control and reduces diabetes-related complications in primary care. METHODS: An 18-month randomized controlled cohort study was conducted in two municipalities in the state of Bahia, Brazil, involving 100 patients with Type 2 diabetes in each municipality. In one municipality, healthcare professionals were trained to use SDM customized protocols for clinical decisions and, in the other municipality, no protocols for diabetes care were implemented. We hypothesized that, in the municipality with SDM trained professionals, patients would have better outcomes, including a fall in glycated haemoglobin (HbA(1c)). RESULTS: Improvements in some metabolic parameters were observed in the SDM group, including a 22% decrease in mean random glucose, a significant 15% decrease in mean HbA(1c), a 6% decrease in systolic blood pressure and an 11% decrease in diastolic blood pressure. There were no differences in body mass index and lipid profile. CONCLUSIONS: SDM customized algorithms are effective, practical and easy to use in primary healthcare teams with very limited resources.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/metabolismo , Atención Primaria de Salud/métodos , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Cohortes , Diabetes Mellitus Tipo 2/sangre , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Estadística como Asunto , Resultado del TratamientoRESUMEN
This paper introduces a new and innovative approach to diabetes management in the primary-care setting. Staged diabetes management (SDM) represents a four-year effort to develop and test a data-based approach to diabetes management that could be easily adapted to a variety of health-care settings in which diabetes management is principally under the direction of primary-care physicians was limited access to specialists. After testing under controlled circumstances at the International Diabetes Center (Minneapolis, MN), SDM was subjected to substantial field trials under conditions that represent the scope and variety of primary-care practices in diabetes. The following represents the work of several investigators who independently undertook a review of SDM.
Asunto(s)
Diabetes Mellitus/terapia , Modelos Teóricos , Bases de Datos Factuales , Atención a la Salud/normas , Diabetes Mellitus/epidemiología , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud , Estados Unidos/epidemiologíaAsunto(s)
Atención Ambulatoria , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insulina/uso terapéutico , Educación del Paciente como Asunto , Consejo , Diabetes Mellitus Tipo 1/enfermería , Diabetes Mellitus Tipo 2/enfermería , Dieta para Diabéticos , Estudios de Seguimiento , HumanosRESUMEN
The Diabetes Home Care Program has been an effective means of providing diabetes management and education to homebound, usually elderly, persons with diabetes. The program appears to be cost effective, the average cost per patient is less than one day of hospitalization. Reimbursement of the program has been good as patients have qualified for reimbursement under Medicare guidelines. Improved diabetes control has been demonstrated following the home care intervention. Since elderly persons with diabetes are frequently referred for home care, it would be appropriate for home care agencies to provide specialized care for persons with diabetes. The Diabetes Home Care Program can serve as a model of diabetes management and education for homebound persons with diabetes.