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The role of the care model in modifying prognosis in diabetes

Authors
Journal
Nutrition Metabolism and Cardiovascular Diseases
0939-4753
Publisher
Elsevier
Volume
23
Issue
1
Identifiers
DOI: 10.1016/j.numecd.2012.07.001
Keywords
  • Models Of Diabetes Care
  • Morbidity And Mortality
  • Hospital Utilization
Disciplines
  • Education
  • Medicine

Abstract

Abstract Organizational factors in diabetes care can influence long- and medium-term outcomes, affecting the prognosis to the same extent as new therapies. A growing body of evidence supports the hypothesis that diabetes team consultation can favorably impact on hospital utilization, the costliest item in diabetes management, as well as on hospitalization rates, inpatient hospital length of stay, and re-admission rates. Moreover, the model of diabetes care has been reported to influence guidelines adherence, an additional factor linked to the variability in the quality of diabetes care. The strongest predictor and effect modifier of the quality of diabetes care is specialist referral. Compared to patients seen in primary care or other settings, those visiting a diabetes center are more likely to be monitored according to guidelines, regardless of the severity-of-disease effect, and to receive structured education, as well as more aggressive treatment when needed. Finally, at least eight published studies suggest that when continuity of care is shared with diabetes clinics, all-cause mortality and major cardiovascular events are both reduced. The sharing of care pathways between primary care providers and diabetes teams is likely to be the best and most affordable solution in the complex management of this chronic condition.

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