Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8553, Japan.
Group Business Development Division, Hankyu Hanshin Holdings Inc, Osaka, Japan.
BMC Endocr Disord. 2022 May 20;22(1):135. doi: 10.1186/s12902-022-01040-4.
Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan.
Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization.
The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization.
The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.
现有研究表明，针对糖尿病患者的疾病管理可能会在短期内通过减少资源利用实现更好的健康结果。然而，由于研究设计的异质性，长期结果并不一致。在本研究中，我们评估了日本全民健康保险计划下针对糖尿病肾病预防的本地疾病管理项目的 5 年随访结果。
我们邀请患有 3 或 4 期糖尿病肾病且年龄在 20 至 75 岁之间的 2 型糖尿病患者参加疾病管理项目，以支持自我管理并在 2011 年至 2013 年期间接受推荐的治疗方案。随访数据来自公共保险计划的电子索赔数据库。考虑到非随机选择过程，我们准备了两组通过估计倾向得分匹配的对照组，以比较糖尿病相关并发症、死亡和资源利用的发生率。
治疗组更有可能按照指南推荐的药物进行临床管理。经过倾向得分匹配后，与主要在初级保健下选择的对照组相比，治疗组的糖尿病肾病和急诊护理使用率较低。与选择更多临床条件的对照组相比，治疗组的发生率和资源利用没有差异。
本研究结果表明，该项目在 5 年随访期间降低并发症发生率和资源利用的效果有限。需要进一步研究初级保健医生、内分泌和肾脏病学专家以及护士教育者共同管理对糖尿病相关肾病的长期有效性。
