UOS Integrazione Cure Primarie e Specialistiche, Azienda Ospedaliera ICP, Milan Dipartimento di Farmacologia Clinica ed Epidemiologia, Consorzio Mario Negri Sud, Via Nazionale 66030, Santa Maria Imbaro (CH), Italy.
Diabet Med. 2011 Jun;28(6):724-30. doi: 10.1111/j.1464-5491.2011.03253.x.
Several chronic care models for diabetes have been implemented in Italy, although conclusive data on their effectiveness are lacking. In the Cusano-Milanino diabetes clinic, patients with Type 2 diabetes with a stable disease/therapy (i.e. a steady level of HbA(1c) without need for therapy changes) are included in the SINERGIA programme: diabetologists, nurses and dietitians empower patients and telemedicine resources are utilized efficiently.
Clinical outcomes measured in the year before and after the initiation of SINERGIA were compared. A generalized hierarchical linear regression model for repeated measures was used.
Altogether, 1004 patients were included; baseline characteristics were (mean ± sd): age 66.6 ± 6.2 years, 54.1% male, diabetes duration 10.8 ± 7.7 years, BMI 29.5 ± 4.8 kg/m(2) , HbA(1c) 6.9 ± 0.9% (52 ± 14 mmol/mol); 72.9% of patients were treated with anti-hypertensive drugs; 32.7% were treated with lipid-lowering drugs. After a median follow-up of 12 months (range 6-24 months), the proportion of patients with HbA(1c) ≤ 7.0% (≤ 53 mmol/mol) increased from 32.7 to 45.8% (P<0.0001), while those with HbA(1c) ≥9% (≥75 mmol/mol) decreased from 10.5 to 4.3% (P<0.0001). Patients with LDL cholesterol <100 mg/dl (<2.59 mmol/l) increased from 40 to 47% (P <0.0001), while those with LDL cholesterol ≥130 mg/dl (≥3.36 mmol/l) decreased from 26.6 to 19.7%; blood pressure levels were slightly improved. The mean number of face-to-face encounters decreased from (median and range) 2.8 (2.3-3.4) to 2.3 (1.9-2.7) (P<0.0001) visits per patient/year.
The SINERGIA model is effective in improving metabolic control and major cardiovascular risk factors, while allowing diabetologists to dedicate more time to patients with more acute disease.
意大利已经实施了几种针对糖尿病的慢性病管理模式，但缺乏关于其有效性的明确数据。在库萨诺-米兰诺糖尿病诊所，将病情/治疗稳定的 2 型糖尿病患者（即 HbA1c 水平稳定，无需改变治疗）纳入 SINERGIA 计划：糖尿病专家、护士和营养师为患者提供支持，并有效利用远程医疗资源。
比较 SINERGIA 启动前后一年的临床结果。使用重复测量的广义分层线性回归模型。
共纳入 1004 例患者；基线特征为（均值±标准差）：年龄 66.6±6.2 岁，54.1%为男性，糖尿病病程 10.8±7.7 年，BMI 29.5±4.8kg/m2，HbA1c 6.9±0.9%（52±14mmol/mol）；72.9%的患者接受抗高血压药物治疗；32.7%的患者接受降脂药物治疗。中位随访 12 个月（6-24 个月）后，HbA1c≤7.0%（≤53mmol/mol）的患者比例从 32.7%增加到 45.8%（P＜0.0001），而 HbA1c≥9%（≥75mmol/mol）的患者比例从 10.5%降至 4.3%（P＜0.0001）。LDL 胆固醇＜100mg/dl（＜2.59mmol/l）的患者比例从 40%增加到 47%（P＜0.0001），而 LDL 胆固醇≥130mg/dl（≥3.36mmol/l）的患者比例从 26.6%降至 19.7%；血压水平略有改善。每位患者/年的面对面就诊次数从（中位数和范围）2.8（2.3-3.4）次减少至 2.3（1.9-2.7）次（P＜0.0001）。
SINERGIA 模式可有效改善代谢控制和主要心血管危险因素，同时使糖尿病专家有更多时间治疗病情更严重的患者。
