Clinical research studyA randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes
Section snippets
Study design
This randomized trial was conducted at the University of North Carolina General Internal Medicine Practice, which serves a wide socioeconomic range of patients. The practice is staffed by more than 20 attending faculty and 70 medical residents who care for more than 2000 patients with diabetes. The study was initiated in February 2001 and was completed in April 2003. The institutional review board approved the study, and written informed consent was obtained from all participating patients.
Participants
Results
From February 2001 to April 2002, 217 patients were randomly assigned to the control or intervention group (Figure 1). Follow-up data were available for 204 patients (94%) at 6 months and 194 (89%) at 12 months, including 4 deaths in the control group and 2 deaths in the intervention group. Eighty-four physicians participated; no physician had more than 10 patients enrolled in the study.
Baseline characteristics were similar between the 2 groups and revealed a sample with poor glycemic control,
Discussion
Our comprehensive pharmacist-led, primary care–based, disease management program improved blood pressure control, aspirin use, and glycemic control among vulnerable patients with type 2 diabetes. We observed a 9-mm Hg greater decrease in systolic blood pressure and a 5-mm Hg greater decrease in diastolic blood pressure in the intervention group than in the control group. In studies such as the Hypertension Optimal Treatment study and the UKPDS,9, 10, 11, 12, 13 long-term decreases in blood
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This project was completed with support from the Robert Wood Johnson Clinical Scholars Program, the University of North Carolina Program on Health Outcomes, the University of North Carolina Division of General Internal Medicine, University of North Carolina Hospital Performance Improvement Department, University of North Carolina Pharmacy, the Vanderbilt Center for Health Services Research, and the Vanderbilt Diabetes Research and Training Center.