Musacchio N.,UOS Integrazione Cure Primarie e Specialistiche |
Lovagnini Scher A.,UOS Integrazione Cure Primarie e Specialistiche |
Giancaterini A.,UOS Integrazione Cure Primarie e Specialistiche |
Pessina L.,UOS Integrazione Cure Primarie e Specialistiche |
And 2 more authors.
Diabetic Medicine | Year: 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 Type2 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±6.2years, 54.1% male, diabetes duration 10.8±7.7years, BMI 29.5±4.8kg/m2, HbA1c 6.9±0.9% (52±14mmol/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 12months (range 6-24months), the proportion of patients with HbA1c≤7.0% (≤53mmol/mol) increased from 32.7 to 45.8% (P<0.0001), while those with HbA1c≥9% (≥75mmol/mol) decreased from 10.5 to 4.3% (P<0.0001). Patients with LDL cholesterol <100mg/dl (<2.59mmol/l) increased from 40 to 47% (P<0.0001), while those with LDL cholesterol ≥130mg/dl (≥3.36mmol/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. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.