Centre for Diabetes and Endocrinology, Johannesburg, South Africa.
Diabet Med. 2010 Feb;27(2):197-202. doi: 10.1111/j.1464-5491.2009.02907.x.
In 1994 the Centre for Diabetes and Endocrinology (CDE) based in Johannesburg, South Africa established a novel community-based capitation and risk-sharing model for diabetes management. We here describe the model and present a recent survey of the performance/outcomes of this unique diabetes care programme.
Data on 17 043 patients managed by the CDE Diabetes Management Programme at its Centre and its 262 affiliated Centres were analysed from its national database. From this total cohort, 1520 Type 1 and 8026 Type 2 diabetes patients have been in the Programme for > 5 years. The 5-year outcome data on hospital admission rates, glycaemic control (HbA(1c)), and microvascular complication rates were assessed in this subgroup of patients.
Major reductions in hospital admission rates for both acute metabolic emergencies and all causes (40% overall) were achieved in patients enrolled onto the Diabetes Management Programme. The mean HBA(1c) on enrolment was 9.2% for subjects with Type 1 and 8.8% for those with Type 2 diabetes. After 1 year, mean HbA(1c) fell to 7.6% and 7.3% for the Type 1 and Type 2 subjects, respectively. At 5 years the HbA(1c) remained similar at 7.7% for the Type 1 subjects and 7.4% for the Type 2 subjects, demonstrating sustained improvement. Progression of microvascular complications appears to have been delayed.
This managed care model of diabetes care in the context of the South African Private Health Care System achieved long-term improvement in glycaemic control and all-cause hospital admission rates. This may be due to the cost-containment being in the hands of the treating doctor, supported by an annual training programme. This programme is based on an individualized and holistic approach encompassing intensive patient education to facilitate self-empowerment and including prompting for the management of risk factors.
1994 年，南非约翰内斯堡的糖尿病和内分泌中心（CDE）建立了一种新颖的基于社区的糖尿病管理人头费和风险共担模式。我们在此描述该模型，并介绍最近对这一独特糖尿病护理计划的绩效/结果的调查。
从其国家数据库中分析了该中心及其 262 个附属中心管理的 17043 名患者的 CDE 糖尿病管理计划的数据。在总队列中，有 1520 名 1 型糖尿病患者和 8026 名 2 型糖尿病患者参加该计划的时间超过 5 年。对该亚组患者的住院率、血糖控制（HbA（1c））和微血管并发症发生率的 5 年结果数据进行了评估。
参加糖尿病管理计划的患者的急性代谢急症和所有原因（总体 40%）的住院率均大幅下降。1 型和 2 型糖尿病患者的平均 HbA（1c）分别为 9.2%和 8.8%。1 年后，1 型和 2 型患者的平均 HbA（1c）分别降至 7.6%和 7.3%。5 年后，1 型患者的 HbA（1c）仍保持在 7.7%，2 型患者的 HbA（1c）保持在 7.4%，表明持续改善。微血管并发症的进展似乎有所延迟。
在南非私人医疗保健系统背景下，这种糖尿病管理的管理式医疗模式在长期改善血糖控制和全因住院率方面取得了成效。这可能是由于治疗医生掌握成本控制，同时通过年度培训计划提供支持。该计划基于个体化和整体方法，包括强化患者教育，以促进自我赋权，并包括提示管理危险因素。
