Carallo Claudio, Scavelli Faustina Barbara, Cipolla Maurizio, Merante Valentina, Medaglia Valeria, Irace Concetta, Gnasso Agostino
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Catanzaro, Italy.
General Practitioners, National Health Service, Catanzaro, Italy.
PLoS One. 2015 May 14;10(5):e0126858. doi: 10.1371/journal.pone.0126858. eCollection 2015.
Type 2 diabetes mellitus T2DM has a huge and growing burden on public health, whereas new care models are not implemented into clinical practice; in fact the purpose of this study was to test the effectiveness of a program of integrated care for T2DM, compared with ordinary diligence.
"Progetto Diabete Calabria" is a new organizational model for the management of patients with diabetes mellitus, based on General Practitioners (GPs) empowerment and the use of a web-based electronic health record, shared in remote consultations among GPs and Hospital Consultants. One-year change in glucose and main cardiovascular risk factors control in 104 patients (Cases) following this integrated care program has been evaluated and compared with that of 208 control patients (Controls) matched for age, gender, and cardiometabolic profile, and followed in an ordinary outpatient medical management by the Consultants only. Both patient groups had Day Hospitals before and after the study period.
The mean number of accesses to the Consultants during the study was 0.6 ± 0.9 for Cases, and 1.3 ± 1.5 for Controls (p<0.0001). At follow-up, glycated hemoglobin (HbA1c) significantly decreased from 58 ± 6 to 54 ± 8 mmol/mol in Cases only (p=0.01); LDL cholesterol decreased in both groups; body mass index decreased in Cases only, from 31.0 ± 4.8 to 30.5 ± 4.6 kg/m(2) (p=0.03).
The present study demonstrates that a health care program based on GPs empowerment and taking care plus remote consultation with Consultants is at least as effective as standard outpatient management, in order to improve the control of T2DM.
2型糖尿病（T2DM）给公共卫生带来了巨大且不断增加的负担，而新的护理模式尚未在临床实践中得到应用；事实上，本研究的目的是测试与常规治疗相比，T2DM综合护理方案的有效性。
“卡拉布里亚糖尿病项目”是一种糖尿病患者管理的新组织模式，基于全科医生（GPs）的授权以及使用基于网络的电子健康记录，该记录在全科医生和医院顾问的远程会诊中共享。对104例患者（病例组）实施该综合护理方案后，评估其血糖和主要心血管危险因素控制的一年变化情况，并与208例年龄、性别和心脏代谢状况相匹配的对照患者（对照组）进行比较，对照组仅由顾问医生进行常规门诊医疗管理。两组患者在研究前后均设有日间医院。
研究期间，病例组患者咨询顾问医生的平均次数为0.6±0.9次，对照组为1.3±1.5次（p<0.0001）。随访时，仅病例组糖化血红蛋白（HbA1c）从58±6显著降至54±8 mmol/mol（p=0.01）；两组低密度脂蛋白胆固醇均下降；仅病例组体重指数下降，从31.0±4.8降至30.5±4.6 kg/m²（p=0.03）。
本研究表明，基于全科医生授权、护理加与顾问医生远程会诊的医疗保健方案在改善T2DM控制方面至少与标准门诊管理同样有效。
