Combining management of type 2 diabetes between a primary care physician and a specialized outpatient clinic may be just as effective for achieving HbA1c outcomes as usual care delivered by endocrinologists, according to findings published in Diabetic Medicine.
“According to WHO, health care systems need to be reconfigured with innovative and integrated models of care for people with chronic diseases with the cooperation of all health care sectors,” Michael E. Røder, MD, DMSc, clinical director and chief physician of the Steno Diabetes Center Odense at Odense University Hospital in Denmark, and colleagues wrote. “One way to concretize integrated care is by adopting shared care models, which can be defined as general practitioners and specialists sharing the delivery of care. ... Focus has been on combining the disease-specific expertise of the endocrinologist with the [general practitioner’s] knowledge of general health and everyday living.”
Røder and colleagues conducted a 12-month prospective, randomized trial with 140 adults with type 2 diabetes and hyperglycemia, hypertension and/or incipient diabetic complications (mean age, 65 years; 26.4% women; mean diabetes duration, 9.1 years; mean HbA1c, 6.9%). Participants were all registered with one of the 29 general practitioners who agreed to participate in the study. All practitioners were recruited from the service area of the Steno Diabetes Center Copenhagen, Gentofte Hospital, University of Copenhagen in Denmark, which was used as the primary outpatient clinic in the trial.
Participants were recruited between August 2015 and December 2016 and randomly assigned at a 1:1 ratio to the shared care program or usual care. The shared program included one comprehensive medical checkup with an endocrinologist at the outpatient clinic and then three quarterly examinations with a primary physician. The usual care group also underwent the comprehensive checkup and then had three quarterly consultations with an endocrinologist, according to the researchers.
The primary outcome of the trial was the mean change in HbA1c in the two groups, with the researchers setting a noninferiority threshold of a mean difference of less than 0.4% between the groups.
After 1 year, the mean change in HbA1c was higher in the shared program group (0.2%) than the usual care group (0.1%) with a mean difference between the groups of 0.1% (90% CI, –0.1 to 0.4). These results confirmed noninferiority between the two groups, according to the researchers, who noted that the usual care group had a higher percentage of participants achieving a predetermined blood pressure target of less than 130/80 mm Hg (37%) compared with the shared care program (17%; P < .01). The researchers also noted that their findings are most translatable to the Danish tax-financed free-accessible health care system, but that they could be “inspiration for other researchers.”
“Provided that the results are sustainable over time, the model can be implemented on a larger scale and allow more people to benefit from the specialized knowledge of the diabetes team,” the researchers wrote. “This could lead to more rational use of health care resources and support the trend of chronic care shifting from the secondary to the primary care health sector.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.