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Review: case management and team changes are particularly effective strategies for reducing HbA1c concentrations in type 2 diabetes

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 Q Which quality improvement (QI) strategies help to improve glycaemic control in patients with type 2 diabetes mellitus?

METHODS

Embedded ImageData sources:

Medline (1966 to April 2006) and Cochrane Effective Practice and Organisation of Care Group database (which includes the results of periodic searches of Medline, EMBASE/Excerpta Medica, and CINAHL), and bibliographies of key articles.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs), quasi-randomised trials, and controlled before-after studies assessing interventions that met the definition for ⩾1 of 11 types of QI strategies (audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, promotion of self management, patient reminder systems, or continuous QI) and reported mean pre-intervention and post-intervention glycated haemoglobin (HbA1c) concentrations in adult outpatients with type 2 diabetes. 66 trials (reported in 58 articles) met the inclusion criteria (50 RCTs, 3 quasi-randomised trials, and 13 controlled before-after trials.

Embedded ImageOutcomes:

HbA1c concentrations.

MAIN RESULTS

Meta-analysis showed …

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