Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial

Diabetes Res Clin Pract. 2010 Apr;88(1):56-64. doi: 10.1016/j.diabres.2009.12.012. Epub 2010 Jan 4.


Aims: To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes.

Methods: During 18 months, we performed a cluster randomized trial with randomization of General Practices. The usual QIP (UQIP: 53 GPs, 918 patients) merged standard interventions including evidence-based treatment protocol, annual benchmarking, postgraduate education, case-coaching for GPs and patient education. The advanced QIP (AQIP: 67 GPs, 1577 patients) introduced additional interventions focussing on intensified follow-up, shared care and patient behavioural changes. Main outcomes were HbA1c, systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL-C), analyzed by generalized estimating equations and linear mixed models.

Results: In UQIP, endpoints improved significantly after intervention: HbA1c -0.4%, 95% CI [-0.4; -0. 3]; SBP -3mmHg, 95% CI [-4; -1]; LDL-C -13mg/dl, 95% CI [-15; -11]. In AQIP, there were no significant additional improvements in outcomes: HbA1c -0.4%, 95% CI [-0.4; -0.3]; SBP -4mmHg, 95% CI [-5; -2]; LDL-C -14mg/dl, 95% CI [-15; -11].

Conclusions: A multifaceted program merging standard interventions in support of general practice induced significant improvements in the quality of diabetes care. Intensified follow-up in AQIP with focus on shared care and patient behaviour changes did not yield additional benefit.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cluster Analysis
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / therapy*
  • Evidence-Based Medicine / economics
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Patient Education as Topic* / economics
  • Physician-Patient Relations
  • Quality of Health Care / economics*
  • Treatment Outcome