Diabetologia

, Volume 45, Issue 9, pp 1231–1239

Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial

Authors

  • M. Trento
    • Department of Internal Medicine, University of Turin
  • P. Passera
    • Department of Internal Medicine, University of Turin
  • M. Bajardi
    • Department of Internal Medicine, University of Turin
  • M. Tomalino
    • Department of Internal Medicine, University of Turin
  • G. Grassi
    • Department of Internal Medicine, University of Turin
  • E. Borgo
    • Department of Internal Medicine, University of Turin
  • C. Donnola
    • Department of Economics, University of Turin
  • F. Cavallo
    • Department of Public Health and Microbiology, University of Turin
  • P. Bondonio
    • Department of Economics, University of Turin
  • M. Porta
    • Department of Internal Medicine, University of Turin, Corso AM Dogliotti 14, 10126 Torino
Article

DOI: 10.1007/s00125-002-0904-8

Cite this article as:
Trento, M., Passera, P., Bajardi, M. et al. Diabetologia (2002) 45: 1231. doi:10.1007/s00125-002-0904-8

Abstract

Aims/hypothesis. Metabolic control worsens progressively in Type II (non-insulin-dependent) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention, when these are implemented on a one-to-one basis. We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications.

Methods. A randomized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education.

Results. Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects. Glycated haemoglobin increased in the control group but not in the group of patients (p<0.001), in whom BMI decreased (p<0.001) and HDL-cholesterol increased (p<0.001). Quality of life, knowledge of diabetes and health behaviours improved with group care (p<0.001, all) and worsened among the control patients (p=0.004 to p<0.001). Dosage of hypoglycaemic agents decreased (p<0.001) and retinopathy progressed less (p<0.009) among the group care patients than the control subjects. Diastolic blood pressure (p<0.001) and relative cardiovascular risk (p<0.05) decreased from baseline in group patients and control patients alike. Over the study period, group care required 196 min and 756.54 US $ per patient, compared with 150 min and 665.77 US $ for the control patients, resulting in an additional 2.12 US $ spent per point gained in the quality of life score.

Conclusion/interpretation. Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment.

Type II diabetes overweight disease management hypoglycaemic agents diabetic retinopathy health education group visits quality of life health behaviours cost-effectiveness

Copyright information

© Springer-Verlag 2002