| Study |
Comparison |
Effect on practice |
Effect on patient |
Notes |
| Benjamin 1999 |
Educational materials + educational meetings + local consensus processes + audit and feedback vs no intervention on diabetes |
Rates of compliance with standards of care:
Annual urine test for albumin/protein (%):
Baseline: 45 vs 67**
Post intervention: 91 vs NA
Absolute difference: NA
Relative improvement: NA
Annual cholesterol determination (%):
Baseline: 58 vs 52
Post intervention: 77 vs NA
Absolute difference: NA
Relative improvement: NA
Annual diabetes education (%):
Baseline: 23 vs 21
Post intervention: 84 vs NA
Absolute difference: NA
Relative improvement: NA
Annual dilated retinal exam (%):
Baseline: 32 vs 59**
Post intervention: 63 vs NA
Absolute difference: NA
Relative improvement: NA
Annual influenza vaccinations (%):
Baseline: 30 vs 24
Post intervention: 73 vs NA
Absolute difference: NA
Relative improvement: NA
Annual nutritional education (%):
Baseline: 37 vs 43
Post intervention: 67 vs NA
Absolute difference: NA
Relative improvement: NA
Rates of compliance with standards of care:
Annual urine test for albumin/protein (%):
Baseline: 45 vs 67**
Post intervention: 91 vs NA
Absolute difference: NA
Relative improvement: NA
Annual cholesterol determination (%):
Baseline: 58 vs 52
Post intervention: 77 vs NA
Absolute difference: NA
Relative improvement: NA
Annual diabetes education (%):
Baseline: 23 vs 21
Post intervention: 84 vs NA
Absolute difference: NA
Relative improvement: NA
Annual dilated retinal exam (%):
Baseline: 32 vs 59**
Post intervention: 63 vs NA
Absolute difference: NA
Relative improvement: NA
Annual influenza vaccinations (%):
Baseline: 30 vs 24
Post intervention: 73 vs NA
Absolute difference: NA
Relative improvement: NA
Annual nutritional education (%):
Baseline: 37 vs 43
Post intervention: 67 vs NA
Absolute difference: NA
Relative improvement: NA |
HbA1c (ref. 3.5‐6.0%):
Baseline: 9.30 ±0.32 vs 9.21±0.32
Post intervention (9 months): 8.42 ± 0.30 vs 9.41± 0.29 (p=0.001)
Post intervention (15 months): 8.68 ±0.28 vs 9.15± 0.32 (p=0.009)
Absolute difference (9 months): 1.01
Absolute difference (15 months): 0.47
Relative improvement: 11%
Relative improvement: 5%
DE‐DC= 1.08 (9 months)
DE‐DC= 0.56 (15 months)
HbA1c (ref. 3.5‐6.0%):
Baseline: 9.30 ±0.32 vs 9.21±0.32
Post intervention (9 months): 8.42 ± 0.30 vs 9.41± 0.29 (p=0.001)
Post intervention (15 months): 8.68 ±0.28 vs 9.15± 0.32 (p=0.009)
Absolute difference (9 months): 1.01
Absolute difference (15 months): 0.47
Relative improvement: 11%
Relative improvement: 5%
DE‐DC= 1.08 (9 months)
DE‐DC= 0.56 (15 months) |
*No post intervention screening rates were reported for the control group. The authors stated that there was little change in screening rates for the control group over the entire study period compared with improvements seen in the intervention group
**Significant difference between both groups at baseline:
for annual urine test for albumin/protein (p<0.05) and for eye exams (p<0.01)
***Rates of compliance with standard outcomes significantly improved for all process outcomes in the intervention group (p<0.001). For annual cholesterol determination p<0.02 |
| Feder 1995 |
Educational materials + local consensus processes + educational outreach visits + reminders vs no intervention on diabetes |
Average % of patients with variable recorded at baseline and after one year (average is weighted by number of patients sampled in practice)
Funduscopy (%):
Baseline: 20.5 vs 19.4
Post intervention: 38.1 vs 20
Absolute difference: 18.1%
Difference in proportions (95% CI)
17.6 (6.9 to 33.9)
Relative improvement: 88%
Blood glucose (%):
Baseline: 56.8 vs 57.8
Post intervention: 75.2 vs 57.8
Absolute difference: 17.4%
Difference in proportions (95% CI)
20.2 (6.4 to 33.9)
Relative improvement: 34.9%
Weight (%):
Baseline: 40.4 vs 37.5
Post intervention: 68.1vs 40
Absolute difference: 28.1%
Difference in proportions (95% CI)
26.5 (7.7 to 45.4)
Relative improvement: 66.3%
Blood pressure (%):
Baseline: 69.0 vs 66.1
Post intervention: 79.5 vs 58.3
Absolute difference: 21.2%
Difference in proportions (95% CI)
18.1 (2.8 to 33.4)
Relative improvement: 31%
Smoking habit (%):
Baseline: 34.8 vs 23.2
Post intervention: 62.4 vs 31.7
Absolute difference: 30.7%
Difference in proportions (95% CI)
25.5 (8.7 to 42.3)
Relative improvement: 80.4%
Feet examination (%):
Baseline: 31.4 vs 28.3
Post intervention: 51.8 vs 27.2
Absolute difference: 24.6%
Difference in proportions (95% CI)
24.7 (7.1 to 42.3)
Relative improvement: 90.8%
HbA1 recorded (%):
Baseline: 24.8 vs 20.6
Post intervention: 48.1 vs 30
Absolute difference: 18.1%
Difference in proportions (95% CI)
13.8 (1.2 to 26.3)
Relative improvement: 46% |
Not done |
*Intervention and control practices had similar distributions of variables at baseline, except for the recording of smoking habit, which was significantly greater in the diabetes practices. Differences at baseline were taken into account in the regression models testing the effect of the guidelines (reported difference in proportions). |
| Kinmonth 1998 |
Educational materials +
educational meetings + educational materials for patients vs no intervention to support patient centred care, but support sessions focusing on use of guidelines and materials |
Not done |
Means with 95% confidence intervals
HbA1c (ref. 4.68‐6.8%):
Post intervention: 7.07 (4.17‐12.83) vs 7.17 (4.16‐14.05)
(N=131 vs 100)
Absolute difference: 0.10
Relative improvement: 1.4%
Adjusted p‐value=0.31*
Total cholesterol (mmol/l):
Post intervention: 6.04 (3.70‐9.80) vs 5.99 (3.30‐9.10)
(N=138 vs 102)
Absolute difference: ‐0.05
Relative improvement: ‐0.8%
Adjusted p‐value=0.92
Triglycerides (mmol/l):
Post intervention: 2.62 (0.60‐13.5) vs 2.23 (0.60‐11.6)
(N=130 vs N=101)
Absolute difference: ‐0.39
Relative improvement:
‐17.5%
Adjusted p‐value=0.02
BMI (kg/m²):
Baseline: 30.6 (18.7‐49.6) vs 29.7 (18.9‐52.2) (N=142 vs 108)
Post intervention: 31.3 (19.8‐51.9) vs 29.5(19.1‐48.5)
(N=138 vs 102)
Absolute difference: ‐1.8
Relative improvement:
‐6%
DE‐DC= ‐0.9
Adjusted p‐value=0.03
Systolic blood pressure (mmHg):
Baseline: 144.1 (80.0‐190.0) vs 141.5 (100.0‐200.0)
(N=142 vs 108)
Post intervention: 144.3 (99.0‐193.5) 142.8 (87.0‐204.0)
(N=138 vs 107)
Absolute difference: ‐1.5
Relative improvement:
‐1%
DE‐DC= 1.1
Adjusted p‐value p=0.18
Diastolic blood pressure (mmHg):
Baseline: 85.5 (60.0‐118.0) vs 83.7 (50.0‐110.0)
(N=142 vs 108)
Post intervention: 89.0 (59.5‐133.5) vs 87.2 (60.5‐131.0)
(N=138 vs 107)
Absolute difference: ‐1.8
Relative improvement:
‐2%
DE‐DC= 0.0
Adjusted p‐value=0.10
Generic
Wellbeing questionnaire overall:
Post intervention: 48.0 (15.0‐66.0) vs 45.9 (3.0‐66.0)
Absolute difference: 2.1
Relative improvement:
5%
Adjusted p‐value=0.03 |
*Analysis was by intention to treat. Multiple or logistic regression was used as appropriate. Adjustments were made for district general hospital, practice list size, organisation of diabetes care, clustering for patients by practice
**The two groups did not differ in micro‐albuminuria, smoking status, diabetes specific quality of life |
| Litzelman 1993 |
Educational materials + reminders + patient education + behavioural contacts with patients + reminders for patients vs no intervention |
Percentage of patients with documentation:
Ulcers (%):
Post intervention: 23.8 vs 11.1
Absolute difference: 12.7%
Relative improvement: 114%
Pulse examination done:
Post intervention: 9.2 vs 3.0
Absolute difference: 6.2%
Relative improvement: 207%
Dry or cracked skin
Post intervention: 8.7 vs 2.0
Absolute difference: 6.7%
Relative improvement: 335%
Calluses or corns:
Post intervention: 6.5 vs 1.0
Absolute difference: 5.5%
Relative improvement: 550%
Fungal infection (foot or nail):
Post intervention: 3.2 vs 0.5
Absolute difference: 2.7%
Relative improvement: 540%
Ingrown nails:
Post intervention: 2.7 vs 0.5
Absolute difference: 2.2%
Relative improvement: 440%
Improperly trimmed nails:
Post intervention: 2.4 vs 0.5
Absolute difference: 1.9%
Relative improvement: 380%
Foot or leg cellulitis
Post intervention: 2.7 vs 1.5
Absolute difference: 1.2%
Relative improvement: 80%
Foot deformities:
Post intervention: 1.6 vs 1.0
Absolute difference: 0.6%
Relative improvement: 60%
Sensory examination done:
Post intervention: 4.9 vs 2.5
Absolute difference: 2.4%
Relative improvement: 96% |
Serious foot lesions:
Baseline prevalence intervention group: 2.9%
OR: 0.41 [0.16‐1.00]**
All foot lesions:
Baseline prevalence intervention group: 10.5%
OR: 0.65 [0.36‐1.17]
Dry or cracked skin:
Baseline prevalence intervention group: 83.5%
OR: 0.62 [0.39‐0.98]
Ingrown nails:
Baseline prevalence intervention group: 18.5%
OR: 0.59 [0.39‐0.92]
Fungal nail infection:
Baseline prevalence intervention group: 67.0%
OR: 0.70 [0.46‐1.07]
Fungal skin infection:
Baseline prevalence intervention group: 12.3%
OR: 0.58 [0.30‐1.12]
Interdigit maceration:
Baseline prevalence intervention group: 18.8%
OR: 0.63 [0.34‐1.15] |
*No p‐value given because of potential unit of analysis error
**adjusted for baseline measurements
***Authors reported significant differences between both groups on
1) the process outcomes: ulcers, pulse examination done, dry or cracked skin, calluses or corns
2) patient outcomes:
dry or cracked skin |
| Lobach 1997 |
Local consensus processes + audit and feedback + reminders vs no intervention |
Compliance rate:
Median baseline compliance levels during 6 months prior to the intervention: 21.2% vs 18.0%
Post intervention: 32.0% vs 15.6%
Absolute difference: 16.4%
Relative improvement: 105%
DE‐DC= 13.2
Foot examination:
Post intervention: 55.6% vs 30.0%
Absolute difference: 25.6%
Relative improvement: 85%
Complete physical examination:
Post intervention: 33.3% vs 6.7%
Absolute difference: 26.6%
Relative improvement: 397%
Chronic glycemia monitoring:
Post intervention: 57.4% vs 52.8%
Absolute difference: 4.6%
Relative improvement: 9%
Urine protein determination:
Post intervention: 73.3% vs 3.9%
Absolute difference: 69.4%
Relative improvement: 1779%
Cholesterol level:
Post intervention: 43.7% vs 13.4%
Absolute difference: 30.3%
Relative improvement: 226%
Ophthalmologic examination:
Post intervention: 18.8% vs 3.2%
Absolute difference: 15.6%
Relative improvement: 488%
Influenza vaccination:
Post intervention: 29.2% vs 22.7%
Absolute difference: 6.5%
Relative improvement: 29% |
Not done |
*No p‐value given because of potential unit of analysis error
**Authors reported p=0.02 for compliance rate. Furthermore, only significant differences between intervention and control group were found for urine protein determination (p=0.01) |
| Mazze 1994 |
Distribution of educational materials + educational meetings + local consensus processes + reminders vs no intervention |
Visits (mean±SD):*
Baseline: 3.0±1.2**
Post intervention: 4.3±1 vs 3.2±1.4 Absolute difference: 1.1
Relative improvement: 34%
Renal evaluation:
Baseline: 50%
Post intervention: 98% vs 50%
Absolute difference: 48%
Relative improvement: 96%
Retinal evaluation:
Baseline: 43%
Post intervention: 98% vs 43%
Absolute difference: 55%
Relative improvement: 127%
Education:
Baseline: 62%
Post intervention: 98% vs 63%
Absolute difference: 35%
Relative improvement: 56%
Health survey:
Baseline: 45%
Post intervention: 98% vs 45%
Absolute difference: 53%
Relative improvement: 118% |
HbA1c (ref. ??)* (mean±SD)**:
Baseline: 10.2±2.8
Post intervention: 8.8±0.7 vs 10.3±0.7
Absolute difference: 1.5
Relative improvement: 15% |
*No p‐values were reported
**The process outcomes and patient outcomes were not reported separately at baseline |
| Mazzuca 1990 |
Group A (control group) postgraduate seminar vs
Group B: A+reminders vs
Group C: B+clinical materials vs
Group D: C+diabetes patient education service |
GHb:
Post intervention B vs A: t=0.44 (n.s.)
Post intervention C vs B: 35% vs 21%
Absolute difference: 14%
Relative improvement: 67%
p<0.05
Post intervention D vs C: 21% vs 35%
Absolute difference: ‐14%
Relative improvement: ‐67%
p<0.05
Difference between groups (ANOVA): F=3.42 (p<0.05)
Fasting blood sugar (only physicians staffing morning clinics N=47):
B vs A: t=0.70 (n.s.)
C vs B: t=‐0.77 (n.s)
D vs C: t=0.14 (n.s)
Difference between groups: (ANOVA): F=0.25 (n.s.)
Home‐monitored blood glucose:
B vs A: t=1.65 (n.s.)
C vs B: t=1.38 (n.s.)
D vs C: t=‐0.84 (n.s.)
Difference between groups: (ANOVA): F=3.27 (p<0.05)
Diet:
B vs A: t=1.10 (n.s.)
C vs B: t=‐0.90 (n.s.)
D vs C: t=1.29 (n.s.)
Difference between groups: (ANOVA): F=1.02 (n.s.)
Oral hypoglycaemic agents:
B vs A: t=0.62 (n.s.)
C vs B: t=0.24 (n.s.)
D vs C: t=0.62 (n.s.)
Difference between groups: (ANOVA): F=0.75 (n.s.) |
Not done |
|
| Palmer 1985 |
Educational materials + local consensus procedures + audit and feedback vs no intervention |
Case‐variant score*:
Baseline mean variant score: 7 vs 6
Change in mean case variant score between baseline and experimental periods in control practices: +3.3
Difference in trend between experimental and control practices: ‐2.0
p=0.26 (SE=1.8) |
Not done |
*(case‐variant score=(criteria not met/ criteria applicable)*100)
**Possible ceiling effect: baseline variant scores are low |
| Pieber 1995 |
Educational materials + educational meetings + patient education vs no intervention |
Not done |
HbA1c (ref. 4.3‐6.1%):
Baseline (mean ± sd): 8.57±1.79 vs 8.77±2.08
Post intervention: 8.11±1.55 vs 9.03±1.79
Absolute difference: 0.92 [0.23‐1.61]
Relative improvement: 11%
DE‐DC= 0.72
Cholesterol (mmol/l):
Baseline: 6.47±1.31 vs 6.57±1.65
Post intervention: 6.07±1.01 vs 6.52±1.77
Absolute difference: 0.45 (n.s.)
Relative improvement: 7%
DE‐DC= 0.35
Triglycerides (mmol/l):
Baseline: 2.99±2.32 vs 2.62±1.79
Post intervention: 2.36±1.75 vs 2.79±2.53
Absolute difference: 0.43 [0.12‐0.84]
Relative improvement: 15%
DE‐DC= 0.80
BMI (kg/m²):
Baseline: 30.2±4.8 vs 30.2±4.7
Post intervention: 29.2±4.5 vs 30.3±4.9
Absolute difference: 1.1 [0.3‐1.9]
Relative improvement: 4%
DE‐DC= 1.1
Body weight (kg):
Baseline: 82.1±14.5 vs 81.8±13.1
Post intervention: 79.4±13.9 vs 82.1±13.6
Absolute difference: 2.7 [1.0‐4.3]
Relative improvement: 3%
DE‐DC= 3
Systolic blood pressure (mmHg):
Baseline: 161±20 vs 157±21
Post intervention: 144±21 vs 150±24
Absolute difference: 6 (n.s.)
Relative improvement: 4%
DE‐DC= 10
Diastolic blood pressure (mmHg):
Baseline: 92±11 vs 91±13
Post intervention: 81±10 vs 86±14
Absolute difference: 5 [0.3‐10.9]
Relative improvement: 6%
DE‐DC= 6
Foot care:
Callus formation:
Baseline: 78% vs 82%
Post intervention: 49% vs 82%
Absolute difference: 33%
Relative improvement: 40%
DE‐DC= 29
Interdigital cracks, interdigital fissures or mycosis
Baseline: 58% vs 53%
Post intervention: 49% vs 65%
Absolute difference: 16%
Relative improvement: 25%
DE‐DC= 21
Margins of the toe nails were cut back, or ingrown toe nails were cut out
Baseline: 87% vs 92%
Post intervention: 27% vs 92%
Absolute difference: 65%
Relative improvement: 71%
DE‐DC= 60 |
*No p‐value given because of potential unit of analysis error
**Authors report significant differences (p=0.01), except for systolic blood pressure (p=0.11), diastolic blood pressure (p=0.05) and cholesterol (p=0.06).
For foot care significant changes were found in the intervention group, but changes remained unchanged in the intervention group |
| Pill 1998 |
Educational meetings + educational outreach visits vs no intervention |
Attendance at practice over last 12 months:
Mean difference in intervention group (N=73): +0.192 (6.35)
Mean difference in control group (N=84): +1.96 (NA) |
**Glyc‐Hb:
Hospital A :
Mean baseline values (SD): 11.70 (2.16) vs 12.06 (2.65)
Mean difference (time1‐time2) (N=56 vs 49): 0.998 (2.70) vs 1.62 (2.95)
Hospital B:
Mean baseline values (SD): 10.20 (1.35) vs 11.53 (1.74)
Mean difference (time1‐time2) (N=15 vs 27):
‐0.447 (2.17) vs 0.311 (2.07)
Hospital A +B:
Mean difference (time1‐time2):
0.693 (2.65) vs 1.153 (2.73)
BMI (kg/m2):
Mean difference: 0.382 (2.44) vs 0.858 (3.73)
Weight (kg) (men):
Mean difference: ‐0.254 (5.56) vs ‐0.379 (7.41)
Weight (kg) (women):
Mean difference: 1.92 (4.55) vs 1.29 (4.93)
Systolic blood pressure (mmHg):
Mean difference: ‐1.47 (21.45) vs 3.12 (19.45)
Diastolic blood pressure ( mmHg):
Mean difference: ‐0.343 (11.56) vs 0.650 (10.81)
Measure of complications:
Mean difference: 0.291 (0.497) vs 0.273 (0.597) |
*No p‐value given because of potential unit of analysis error
**In hospital B Glyc‐Hb was significant different in both groups at baseline for the other outcomes it is not clear
***The reference ranges for glyco‐Hb over time were revised by the laboratories during the study period, thus giving a potentially false impression of overall improvement if the raw data alone were inspected.
Authors reported no significant differences in changes over time between both groups.
Only for one item with regard to health status (SF‐36) a sign difference over time was found:
physical functioning, as measured by self‐reports of limitations to everyday activities:
P=0.02
(women p=0.03)
(men p=0.31) |
| Ward 1996 |
Educational materials + educational outreach visits + audit and feedback by interview vs educational materials + postal feedback |
Group 1=doctor interview
Group 2=nurse interview
Group 3=control group
History:
Duration of known diabetes recorded:
Baseline: 56.9% vs 33.9% vs 31.1%
Post intervention: 60.8% vs 38.0% vs 31.1%
Absolute difference group 1: 22.8%
Absolute difference group 2: 6.9%
Relative improvement group 1: 95%
Relative improvement group 2: 22%
DE‐DC group 1= 3.9
DE‐DC group 2= 4.1
* No significant changes within groups
Dietary inquiry and advice:
Baseline: 60.0% vs 43.0% vs 43.7%
Post intervention: 64.6% vs 55.4% vs 44.4%
Absolute difference group 1: 20.2%
Absolute difference group 2: 11.0%
Relative improvement group 1: 45%
Relative improvement group 2: 25%
DE‐DC group 1= 3.9
DE‐DC group 2= 11.7
* Only significant change within group 2: p<0.05
Annual physical examination
Blood pressure
Baseline: 86.2% vs 81.0% vs 85.9%
Post intervention: 90.0% vs 85.1% vs 88.1%
Absolute difference group 1: 1.9%
Absolute difference group 2: ‐3.0%
Relative improvement group 1: 2%
Relative improvement group 2:‐3%
DE‐DC group 1= 1.6
DE‐DC group 2= 1.9
* No significant changes within groups
Eye examination (or referral to ophthalmologist)
Baseline: 23.1% vs 19.8% vs 29.6%
Post intervention: 42.3% vs 40.5% vs 31.1%
Absolute difference group 1: 11.2%
Absolute difference group 2: 9.4%
Relative improvement group 1: 36%
Relative improvement group 2: 30%
DE‐DC group 1= 7.7
DE‐DC group 2= 19.2
* Significant changes within group 1 (p<0.01) and within group 2 (p<0.001)
Body weight
Baseline: 47.7% vs 38.0% vs 35.6%
Post intervention: 67.7% vs 46.3% vs 43.3%
Absolute difference group 1: 24.4%
Absolute difference group 2: 3.0%
Relative improvement group 1: 56%
Relative improvement group 2: 7%
DE‐DC group 1= 12.3
DE‐DC group 2= 0.6
* Significant changes within group 1 (p<0.001)
Feet examined:
Pulses:
Baseline: 18.5% vs 7.4% vs 15.6%
Post intervention: 38.5% vs 26.4% vs 15.6%
Absolute difference group 1: 22.9%
Absolute difference group 2: 10.8%
Relative improvement group 1: 147%
Relative improvement group 2: 69%
DE‐DC group 1= 20.0
DE‐DC group 2= 19.0
* Significant changes within group 1 (p<0.001) and within group 2 (p<0.0001)
Sensation:
Baseline: 9.2% vs 9.1% vs 10.4%
Post intervention: 26.2% vs 20.7% vs 11.9%
Absolute difference group 1: 14.3%
Absolute difference group 2: 8.8%
Relative improvement group 1: 120%
Relative improvement group 2: 74%
DE‐DC group 1= 15.5
DE‐DC group 2= 10.1
* Significant changes within group 1 (p<0.001) and within group 2 (p<0.05)
Nails:
Baseline: 14.6% vs 8.3% vs 10.4%
Post intervention: 20.0% vs 12.4% vs 8.1%
Absolute difference group 1: 11.9%
Absolute difference group 2: 4.3%
Relative improvement group 1: 147%
Relative improvement group 2: 53%
DE‐DC group 1= 7.8
DE‐DC group 2= 6.4
* No significant changes within groups
Reflexes:
Baseline: 4.6% vs 5.0% vs 5.2% Post intervention: 21.5% vs 17.4% vs 8.1%
Absolute difference group 1: 13.4%
Absolute difference group 2: 9.3%
Relative improvement group 1: 165%
Relative improvement group 2: 115%
DE‐DC group 1= 14.0
DE‐DC group 2= 9.5
* Significant changes within group 1 (p<0.001) and within group 2 (p<0.01)
HbA1 (1 per 8 months):
Baseline: 36.9% vs 28.9% vs 46.7%
Post intervention: 54.6% vs 44.6% vs 40.7%
Absolute difference group 1: 13.9%
Absolute difference group 2: 3.9%
Relative improvement group 1: 34%
Relative improvement group 2: 10%
DE‐DC group 1= 23.7
DE‐DC group 2= 21.7
* Significant changes within group 1 (p<0.001) and within group 2 (p<0.05)
Blood glucose (2 per 8 months):
Baseline: 46.2% vs 48.8% vs 36.3%
Post intervention: 58.5% vs 52.1% vs 37.8%
Absolute difference group 1: 20.7%
Absolute difference group 2: 14.3%
Relative improvement group 1: 55%
Relative improvement group 2: 38%
DE‐DC group 1= 10.8
DE‐DC group 2= 1.8
* Significant changes within group 1 (p<0.05)
Cholesterol (1 per 8 months):
Baseline: 26.2% vs 19.8% vs 23.7%
Post intervention: 39.2% vs 25.6% vs 25.9%
Absolute difference group 1: 13.3%
Absolute difference group 2: ‐0.3%
Relative improvement group 1: 51%
Relative improvement group 2:
‐1%
DE‐DC group 1= 10.8
DE‐DC group 2= 3.6
* Significant changes within group 1 (p<0.05)
Triglycerides (1 per 8 months):
Baseline: 21.5% vs 19.0% vs 20.7%
Post intervention: 34.6% vs 24.8% vs 23.0%
Absolute difference group 1: 11.6%
Absolute difference group 2: 1.8%
Relative improvement group 1: 50%
Relative improvement group 2: 8%
DE‐DC group 1= 10.8
DE‐DC group 2= 3.5
* Significant changes within group 1 (p<0.01)
Overall modified Adequate Competent Care (ACC) score (SD):
Baseline: 4.3 (2.3) vs 3.5 (2.0) vs 3.7( 2.0)
Post intervention: 6.1 (3.1) vs 4.8 (2.9) vs 4.0 (2.2)
Absolute difference group 1: 2.1
Absolute difference group 2: 0.7%
Relative improvement group 1: 53%
Relative improvement group 2: 20%
DE‐DC group 1= 1.5
DE‐DC group 2= 1.0
* Significant difference between groups p<0.0001
Contrast ACC‐score:
No interview vs interview: p<0.001
No interview vs doctor interview: p<0.001
No interview vs nurse interview: p<0.01
Doctor interview vs nurse interview: N.S. |
Not done |
Other reported items:
With regard to history:
alcohol intake inquiry and advice, exercise inquiry and advice, smoking inquiry and advice and impotence/vaginitis inquiry and advice showed significant differences within the doctor interview group and also within the nurse interview group
With regard to blood tests:
creatinine showed significant differences within the doctor interview group (p<0.0001) and within the nurse interview group (p<0.01)
With regard to urinalysis:
glucose and nitrite showed no significant differences within groups. Only protein showed a slight significant difference within the nurse interview group (p<0.05) |
| Carlson 1991 |
Educational meetings + local consensus processes to identify problems and to create plans to improve diabetes care
+ educational outreach visits
vs no intervention |
Patients height noted in case notes during previous year:
Post intervention: 73% vs 50%
Absolute difference: 23%
Relative improvement: 46%
HbA1c value measured during previous year:
Post intervention: 27% vs 8%
Absolute difference: 19%
Relative improvement: 238%
Eye examination performed during previous year:
Post intervention: 40% vs 28%
Absolute difference: 12%
Relative improvement: 43% |
Of a 20% secondary sample (806 patients) 566 patients had their HbA1c value measured
HbA1c (mean±SD):
Post intervention: 8.1±1.8 vs 7.8±1.6
Absolute difference: ‐0.3
Relative improvement:
‐4% |
*No p‐value given because of potential unit of analysis error
**Authors report significant differences for patients height noted in case notes (p<0.01), HbA1c value measured (p<0.001) and eye examination performed p<0.01.
For HbA1c they report that both groups have a similar degree of metabolic control, p‐value is not reported. |
