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Effects of structured hospital-based care compared with standard care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a randomized trial.
Diabet Med. 2007 Sep; 24(9):1019-27.DM

Abstract

AIMS

Few studies have compared structured vs. standard care on the effects of modifying several cardiovascular (CV) risk factors in subjects with Type 2 diabetes. Because of the complexity of the disease, we hypothesized that structured care with a multi-interventional approach is necessary to effectively reach treatment goals and to reduce CV risk.

METHODS

An open 2-year parallel-group study in 120 patients (age 59 +/- 10 years, 31 females) with Type 2 diabetes (median duration 4 years) was conducted. The patients were randomized to standard care (follow-up by their general practitioner) or to structured care at a hospital outpatient clinic consisting of an initial 6 months' lifestyle programme followed by targeted intensified pharmacological treatment to reach prespecified goals for glycaemic, lipid and blood pressure (BP) control. The primary outcome was change in the estimated 10-year absolute risk for fatal coronary heart disease (CHD).

RESULTS

One hundred and six patients completed the study. Improvements were greater among patients receiving structured rather than standard care for systolic BP, triglycerides, glucose and glycated haemoglobin (HbA(1c)) (P < 0.05), as well as for the estimated 10-year CHD-risk (17.9% to 14.5% vs. 18.3% to 19.6%) and the prevalence of a CHD risk >or= 20% (38% to 22% vs. 39% to 45%). Most of the reduction in estimated CHD risk (77%) in the structured care group was obtained during the period (6-24 months) with intensified pharmacological treatment (P < 0.01).

CONCLUSIONS

This study shows that 2 years of structured care combining lifestyle and pharmacological interventions improved several CV risk factors and reduced the estimated 10-year absolute risk for CHD in patients with Type 2 diabetes.

Authors+Show Affiliations

Medical Department, Asker and Baerum Hospital, Rud, Norway. odd.erik.johansen@broadpark.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17509068

Citation

Johansen, O E., et al. "Effects of Structured Hospital-based Care Compared With Standard Care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a Randomized Trial." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 24, no. 9, 2007, pp. 1019-27.
Johansen OE, Gullestad L, Blaasaas KG, et al. Effects of structured hospital-based care compared with standard care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a randomized trial. Diabet Med. 2007;24(9):1019-27.
Johansen, O. E., Gullestad, L., Blaasaas, K. G., Orvik, E., & Birkeland, K. I. (2007). Effects of structured hospital-based care compared with standard care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a randomized trial. Diabetic Medicine : a Journal of the British Diabetic Association, 24(9), 1019-27.
Johansen OE, et al. Effects of Structured Hospital-based Care Compared With Standard Care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a Randomized Trial. Diabet Med. 2007;24(9):1019-27. PubMed PMID: 17509068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of structured hospital-based care compared with standard care for Type 2 diabetes-The Asker and Baerum Cardiovascular Diabetes Study, a randomized trial. AU - Johansen,O E, AU - Gullestad,L, AU - Blaasaas,K G, AU - Orvik,E, AU - Birkeland,K I, Y1 - 2007/05/17/ PY - 2007/5/19/pubmed PY - 2007/12/11/medline PY - 2007/5/19/entrez SP - 1019 EP - 27 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 24 IS - 9 N2 - AIMS: Few studies have compared structured vs. standard care on the effects of modifying several cardiovascular (CV) risk factors in subjects with Type 2 diabetes. Because of the complexity of the disease, we hypothesized that structured care with a multi-interventional approach is necessary to effectively reach treatment goals and to reduce CV risk. METHODS: An open 2-year parallel-group study in 120 patients (age 59 +/- 10 years, 31 females) with Type 2 diabetes (median duration 4 years) was conducted. The patients were randomized to standard care (follow-up by their general practitioner) or to structured care at a hospital outpatient clinic consisting of an initial 6 months' lifestyle programme followed by targeted intensified pharmacological treatment to reach prespecified goals for glycaemic, lipid and blood pressure (BP) control. The primary outcome was change in the estimated 10-year absolute risk for fatal coronary heart disease (CHD). RESULTS: One hundred and six patients completed the study. Improvements were greater among patients receiving structured rather than standard care for systolic BP, triglycerides, glucose and glycated haemoglobin (HbA(1c)) (P < 0.05), as well as for the estimated 10-year CHD-risk (17.9% to 14.5% vs. 18.3% to 19.6%) and the prevalence of a CHD risk >or= 20% (38% to 22% vs. 39% to 45%). Most of the reduction in estimated CHD risk (77%) in the structured care group was obtained during the period (6-24 months) with intensified pharmacological treatment (P < 0.01). CONCLUSIONS: This study shows that 2 years of structured care combining lifestyle and pharmacological interventions improved several CV risk factors and reduced the estimated 10-year absolute risk for CHD in patients with Type 2 diabetes. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/17509068/Effects_of_structured_hospital_based_care_compared_with_standard_care_for_Type_2_diabetes_The_Asker_and_Baerum_Cardiovascular_Diabetes_Study_a_randomized_trial_ L2 - https://doi.org/10.1111/j.1464-5491.2007.02198.x DB - PRIME DP - Unbound Medicine ER -