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Open Access Highly Accessed Research article

Care management for Type 2 diabetes in the United States: a systematic review and meta-analysis

Jason S Egginton12, Jennifer L Ridgeway2, Nilay D Shah12, Saranya Balasubramaniam1, Joann R Emmanuel1, Larry J Prokop1, Victor M Montori13 and Mohammad Hassan Murad124*

Author Affiliations

1 Division of Preventive Medicine and the Knowledge and Evaluation Research Unit, 200 First Street SW, 55905 Rochester, MN, USA

2 Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA

3 Division of Endocrinology, Mayo Clinic, Rochester, MN, USA

4 Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA

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BMC Health Services Research 2012, 12:72  doi:10.1186/1472-6963-12-72

Published: 22 March 2012

Abstract

Background

This systematic review and meta-analysis aims at assessing the composition and performance of care management models evaluated in the last decade and their impact on patient important outcomes.

Methods

A comprehensive literature search of electronic bibliographic databases was performed to identify care management trials in type 2 diabetes. Random effects meta-analysis was used when feasible to pool outcome measures.

Results

Fifty-two studies were eligible. Most commonly reported were surrogate outcomes (such as HbA1c and LDL), followed by process measures (clinic visit or testing frequency). Less frequently reported were quality of life, patient satisfaction, self-care, and healthcare utilization. Most care management modalities were carved out from primary care. Meta-analysis demonstrated a statistically significant but trivial reduction of HbA1c (weighted difference in means -0.21%, 95% confidence interval -0.40 to -0.03, p < .03) and LDL-cholesterol (weighted difference in means -3.38 mg/dL, 95% confidence interval -6.27 to -0.49, p < .02).

Conclusions

Most care management programs for patients with type 2 diabetes are 'carved-out', accomplish limited effects on metabolic outcomes, and have unknown effects on patient important outcomes. Comparative effectiveness research of different models of care management is needed to inform the design of medical homes for patients with chronic conditions.

Keywords:
Chronic Care: disease management/care management; Endocrinology: diabetes, Evidence-based medicine/critical review of evidence