Impact of a chronic care model based on patient empowerment on the management of Type 2 diabetes: effects of the SINERGIA programme

Diabet. Med. 28, 724–730 (2011) Aims Several chronic care models for diabetes have been implemented in Italy, although conclusive data on their effectiveness are lacking. In the Cusano‐Milanino diabetes clinic, patients with Type 2 diabetes with a stable disease/therapy (i.e. a steady level of HbA1...

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Published in:	Diabetic medicine Vol. 28; no. 6; pp. 724 - 730
Main Authors:	Musacchio, N., Lovagnini Scher, A., Giancaterini, A., Pessina, L., Salis, G., Schivalocchi, F., Nicolucci, A., Pellegrini, F., Rossi, M. C. E.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-06-2011 Blackwell
Subjects:	Aged Biological and medical sciences Blood Glucose Cholesterol, LDL - blood Cholesterol, LDL - drug effects chronic care model Delivery of Health Care - standards Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - therapy Diabetes. Impaired glucose tolerance empowerment Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Glycated Hemoglobin A - metabolism Humans Hypoglycemic Agents - administration & dosage intermediate outcome indicators Italy - epidemiology Male Medical sciences Patient Care Team Patient Satisfaction Patient-Centered Care Program Evaluation Self Efficacy Treatment Outcome Type 2 diabetes Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology Italy Endocrinopathy Type 2 diabetes Human Obesity Prognosis intermediate outcome indicators Nutrition Chronic disease Nutrition disorder Patient Metabolic diseases Indicator Chronic care model Empowerment Clinical management Treatment Evolution Autonomy Endocrinology Nutritional status
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Summary:	Diabet. Med. 28, 724–730 (2011) Aims Several chronic care models for diabetes have been implemented in Italy, although conclusive data on their effectiveness are lacking. In the Cusano‐Milanino diabetes clinic, patients with Type 2 diabetes with a stable disease/therapy (i.e. a steady level of HbA1c without need for therapy changes) are included in the SINERGIA programme: diabetologists, nurses and dietitians empower patients and telemedicine resources are utilized efficiently. Methods Clinical outcomes measured in the year before and after the initiation of SINERGIA were compared. A generalized hierarchical linear regression model for repeated measures was used. Results Altogether, 1004 patients were included; baseline characteristics were (mean ± sd): age 66.6 ± 6.2 years, 54.1% male, diabetes duration 10.8 ± 7.7 years, BMI 29.5 ± 4.8 kg/m2, HbA1c 6.9 ± 0.9% (52 ± 14 mmol/mol); 72.9% of patients were treated with anti‐hypertensive drugs; 32.7% were treated with lipid‐lowering drugs. After a median follow‐up of 12 months (range 6–24 months), the proportion of patients with HbA1c≤ 7.0% (≤ 53 mmol/mol) increased from 32.7 to 45.8% (P < 0.0001), while those with HbA1c≥ 9% (≥ 75 mmol/mol) decreased from 10.5 to 4.3% (P < 0.0001). Patients with LDL cholesterol < 100 mg/dl (< 2.59 mmol/l) increased from 40 to 47% (P < 0.0001), while those with LDL cholesterol ≥ 130 mg/dl (≥ 3.36 mmol/l) decreased from 26.6 to 19.7%; blood pressure levels were slightly improved. The mean number of face‐to‐face encounters decreased from (median and range) 2.8 (2.3–3.4) to 2.3 (1.9–2.7) (P < 0.0001) visits per patient/year. Conclusions The SINERGIA model is effective in improving metabolic control and major cardiovascular risk factors, while allowing diabetologists to dedicate more time to patients with more acute disease.
Bibliography:	ark:/67375/WNG-CRL2FTCX-M ArticleID:DME3253 istex:E3B1D5F55BDDCE0618097E83D7A9D02E10A60870 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0742-3071 1464-5491
DOI:	10.1111/j.1464-5491.2011.03253.x