medigraphic.com

2007, Number 4

<< Back Next >>

Rev Med Inst Mex Seguro Soc 2007; 45 (4)

Effect of a Clinical Practice Guideline for the Management of Diabetes Type 2

Pérez-Cuevas R, Reyes-Morales H, Flores-Hernández S, Wacher-Rodarte N

Language: Spanish
References: 32
Page: 353-360
PDF size: 187.63 Kb.


ABSTRACT

Objective: to evaluate the efficacy of a clinical practice guideline for treating type-2 diabetes patients in family medicine clinics.
Material method: non randomized control trial that took place in two family medicine clinics. Patients with more than 10 years of being diabetic were included. The study comprised one intervention group and one control group. The intervention group was treated by family doctors previously trained to use the guideline, while the control group was treated by family doctors unaware about the clinical practice guideline. The clinical practice guideline identifies disease risk factors, classifies the disease, and indicates criteria for diagnosis, pharmacological treatment, monitoring and timely identification of acute complications. It also addresses patients’ education regarding dietary and exercise recommendations. The study had three stages: baseline, intervention and post-intervention. Study outcomes: the primary outcome was control of glycemia, determined by HbA1c levels. The criterion for control was an HbA1c value of 7 % or below. Secondary outcomes were changes in lifestyle, body mass index, cholesterol and triglyceride levels.
Results: of the 419 patients with type-2 diabetes included in the study, 340 (81 %, 175 intervention group and 165 control group) completed the six-month follow-up. In the final evaluation, the mean HbA1c in the intervention group had decreased from 9 to 8.3 %, while it increased from 8.9 to 9.5 % in the control group (p ‹ 0.001). The proportion of obese patients decreased in the intervention group but remained the same in the control group.
Conclusion: the clinical practice guideline was effective in improving the HbA1c level and decreasing the proportion of obese patients.


REFERENCES

  1. Audet A, Greenfield S, Field M. Medical practice guidelines: current activities and future directions. Ann Intern Med 1990;113:709-714.

  2. Sackett D. Clinical diagnostic strategies. En: Sackett D, Haynes R, Tugwell P, editors. Clinical epidemiology: a basic science for clinical medicine. Toronto: Little, Brown; 1985. p. 3-15.

  3. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Disponible en http://www.ausinfo.gov.au/general/gen_hottobuy. htm

  4. Benjamin E, Schneider M, Hinchey K. Implement-ing practice guidelines for diabetes care using problem-based learning: a prospective controlled trial using firm systems. Diabetes Care 1999;22: 1672-1678.

  5. Cabana M, Rand C, Powe N, Wu A, Wilson M, Abboud P et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458-1465.

  6. Garfield F, Garfield J. Clinical judgment and clinical practice guidelines. Int J Technol Assess 2000;16:1050-1060.

  7. Pérez-Cuevas R, Reyes H, Guiscafré H, Juárez-Díaz N, Oviedo M, Flores S et al. The primary care clinic as a setting for continuing medical education: program description. CMAJ 2000;163:1295-1299.

  8. Oviedo-Mota MA, Espinosa-Larrañaga F, Reyes-Morales H, Trejo-y Pérez JA, Gil-Velázquez E. Guía clínica para el diagnóstico y tratamiento de la diabetes mellitus tipo 2. Rev Med IMSS 2003;41 (Suppl):S27-S46.

  9. Oviedo-Mota MA, Pérez-Cuevas R, Castañeda-Limones R, Reyes-Morales H. Guía para la prescripción de alimentación para el paciente diabético tipo 2. Una propuesta aplicable en atención primaria. Rev Med IMSS 2000;38:285-293.

  10. American Diabetes Association. Standards of medical care for patients with diabetes melllitus. Diabetes Care 2002;25:S33-S49.

  11. Albu J, Konnarides C, Pi-Sunyer F. Weight control, metabolic and cardiovascular effects. Diabetes Rev 1995;3:335-347.

  12. Amatruda JM, Richerson JF, Welle SL, Brodows RG, Lockwood DH. The safety and efficacy of a controlled low energy (very-low calorie) diet in the treatment of non-insulin-dependent diabetes mellitus and obesity. Arch Intern Med 1988;148:873-877.

  13. Cooppan R. General approach to the treatment of diabetes. En: Kahn C, Weir G, editors. Joslin’s diabetes mellitus. Philadelphia: Lea and Febiger; 1994. p. 397-403.

  14. Baecke questionnaire of habitual physical activity. Offic J Am Coll Sports Med 1997;29:S15-S18.

  15. Modified Baecke questionnaire for older adults. Offic J Am Coll Sports Med 1997;29:S117-S121.

  16. Must A, Spadano J, Coakley E, Field A, Colditz G, Dietz W. The disease burden associated with over-weight and obesity. JAMA 1999;282:1523-1529.

  17. Hernández-Ávila M, Romieu I, Parra S, Hernández-Ávila J, Madrigal H, Willett W. Validity and reproducibility of a food frequency questionnaire to assess dietary intake of women living in Mexico City. Salud Publica Mex 1998;39:133-149.

  18. Meinert C. Clinical trials design, conduct, and analysis. New York: Oxford University Press; 1986. p. 71-89.

  19. Obesity Task Force. Clinical guidelines on the identification, evaluation and treatment for overweight and obesity in adults. Obes Res 1998; 6:51S-209S.

  20. Hellman R, Regan J, Rosen H. Effect of intensive treatment of diabetes of the risk of death or renal failure in NIDDM and IDDM. Diabetes Care 1997;20:258-264.

  21. Moss S, Klein R, Klein B, Meuer S. The association of glycemia and cause-specific mortality in a diabetic population. Arch Intern Med 1994;154:2473-2479.

  22. Tanaka Y, Atsumi Y, Matsuoka K, Onuma T, Tohjima T, Kawamori R. Role of glycemic control and blood pressure in the development and pro-gression of nephropathy in elderly Japanese NIDDM patients. Diabetes Care 1998;21:116-120.

  23. Wallace T, Matthews DR. Poor glycemic control in type 2 diabetes: a conspiracy of disease, suboptimal therapy and attitude. QJM 2000;93:369-374.

  24. Kelley DE, Wing R, Buonocore C, Sturis J, Polonsky K, Fitzsimmons M. Relative effects of calorie restriction and weight loss in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1993; 77:1287-1293.

  25. Berger M, Jörgens V, Flatten G. Health care for persons with non insulin dependent diabetes mellitus. The German experience. Ann Intern Med 1996;124:153-155.

  26. Hensrud D. Dietary treatment and long-term weight loss and maintenance in type 2 diabetes. Obes Res 2001;9(Suppl 4):348S-353S.

  27. Barnard R, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care 1994;17:1469-1472.

  28. Boule N, Haddad E, Kenny G, Wells G, Sigal R. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001;286: 1218-1227.

  29. Wallberg-Henriksson H, Rincon J, Zierath J. Exercise in the management of non-insulin-dependent diabetes mellitus. Sport Med 1998;25: 25-35.

  30. McTique K, Harris R, Hemphill B, Lux L, Sutton S, Bunton A. Screening and interventions for obesity in adults: summary of the evidence for the US. Preventive Services Task Force. Ann Intern Med 2003;139:933-949.

  31. Larme A, Pugh J. Attitudes of primary care providers toward diabetes, barriers to guideline imple-mentation. Diabetes Care 1998;21:1391-1396.

  32. Renders C, Valk G, Griffin S, Wagner E, Eijk Van J, WA. Interventions to improve the management of diabetes in primary care, outpatient and community settings. Diabetes Care 2001;24:1821-1833.




2020     |     www.medigraphic.com