Improving glycaemic control of patients with Type 2 diabetes in a primary care setting: a French application of the Staged Diabetes Management programme

• Published in: Diabetic medicine Vol. 21; no. 6; pp. 592 - 598
• Main Authors: Varroud-Vial, M., Simon, D., Attali, J., Durand-Zaleski, I., Bera, L., Attali, C., Letondeur, C., Strauss, K., Petit, C., Charpentier, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-06-2004; Blackwell
• Subjects: Biological and medical sciences; Blood Glucose - analysis; Blood Glucose Self-Monitoring - methods; Blood Pressure - physiology; Costs and Cost Analysis; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - analysis; health outcomes; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Practice Guidelines as Topic; primary care; Primary Health Care - economics; Primary Health Care - methods; Prospective Studies; Quality of Life; randomized controlled trial; Referral and Consultation; staged diabetes management; Treatment Outcome; Type 2 diabetes mellitus; Endocrinopathy; Type 2 diabetes; Human; Prognosis; Primary health care; staged diabetes management; Type 2 diabetes mellitus; randomized controlled trial; health outcomes; Regulation(control); Treatment; Clinical trial; primary care; Application; Public health
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2004.01207.x

Aims  To assess the impact of a French adaptation of the Staged Diabetes Management (SDM) programme on glycaemic control of people with Type 2 diabetes in primary care. Secondary endpoints were blood pressure, blood lipids, healthcare costs and quality of life.
Methods  Prospective, randomized controlled study, of 1 years’ duration. General practitioners (GPs) were recruited in four separate districts of a French region. They enrolled consecutive patients with Type 2 diabetes. GPs in the intervention group were educated in the SDM programme. GPs in the control group were asked to provide usual care. Healthcare costs were collected by medical departments of the Health Insurance systems. Quality of life was assessed with the Duke Health Profile.
Results  Three hundred and forty patients enrolled by 57 GPs completed the study, 192 in the intervention group and 148 in the control group. Patients in the intervention group were managed more adequately in accordance with the guidelines (P < 0.05 for nine out of 10 items). HbA1c decreased by 0.31% in the intervention group and increased by 0.56% in the control group, resulting in a difference of 0.87% by the end of the study (P = 0.001). Blood pressure and blood lipids did not differ between groups. Occurrence of major complications was low and identical in both groups. Incremental costs during the study in the intervention group were 35 euros per patient per month, and this was not significantly different in comparison with the control group. Quality of life was not affected by the intervention.
Conclusions  Educating GPs in the French adaptation of the SDM programme improves glycaemic control in a primary care setting, without significantly increasing healthcare costs.