Disease management programmes are multi-faceted interventions to improve standards of care. Diabetes disease management often comprises a combination of patient education, psychological support, lifestyle support, self-monitoring and telemedicine. This review looked at how effective they are at controlling blood sugar levels.
Clinical question:
In diabetes care, do disease management programmes lead to better glycaemic control?
The evidence:
41 randomised trials were found. It was not clear how many patients were involved.
The reviewers combined the data from these studies and found that disease management programmes improved HbA1c by an average equivalent of 0.51. Further analysis showed the the greatest effect was found where patients had higher initial HbA1c.
They concluded that further research is needed to show:
- the impact of disease management on health over the longer term
- which groups benefit most
- the cost-effectiveness of these interventions.
Appraisal hints:
The Centre for Reviews and Dissemination appraised this review and concluded that there was some risk of bias. Specifically:
- The review excluded non-English language papers and could have done more to identify unpublished research.
- The literature search was carried out in December 2009.
- Some key aspects of study quality were not reported.
- Follow-up rates were low in some studies.
- The results could have been due to confounding.
- There was important heterogeneity between the studies.
Reference:
The full text is available from the Canadian Medical Association Journal.
Pimouguet C, Le Goff M, Thiebaut R, Dartigues JF, Helmer C. Effectiveness of disease-management programs for improving diabetes care: a meta-analysis. CMAJ: Canadian Medical Association Journal 2011; 183(2): E115-E127
The CRD’s appraisal is available from the Database of Abstract of Reviews of Effectiveness (DARE).
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.
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