Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis

Systematic Reviews

Systematic Review Update

Chiew Jiat Rosalind Siah¹  Wilson Wai San Tam¹  E Shyong Tai²  Doris Yee Ling Young³  Lay Hoon Goh³ 

[1] Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, 119228, Singapore, Singapore;

关键词: Chronic Care Model;    Chronic disease;    Disease management;    Meta-analysis;    Patient care team;    Self-management;    Systematic review;    Type 2 diabetes;   

DOI  :  10.1186/s13643-022-02117-w

 received in 2022-05-16, accepted in 2022-11-02,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundMixed evidence exists regarding the effectiveness of the Chronic Care Model (CCM) with patient outcomes. The aim of this review is to examine the effectiveness of CCM interventions on hemoglobin A1c (HbA1c), systolic BP (SBP), diastolic BP (DBP), LDL cholesterol and body mass index (BMI) among primary care adults with type 2 diabetes.MethodsPubMed, Embase, CINAHL, Cochrane Central Registry of Controlled Trials, Scopus and Web of Science were searched from January 1990 to June 2021 for randomized controlled trials (RCTs) comparing CCM interventions against usual care among adults with type 2 diabetes mellitus in primary care with HbA1c, SBP, DBP, LDL cholesterol and BMI as outcomes. An abbreviated search was performed from 2021 to April 2022. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction and Cochrane risk of bias assessment. Two reviewers independently extracted the data. Meta-analysis was performed using Review Manager software. Heterogeneity was evaluated using χ2 and I2 test statistics. Overall effects were evaluated using Z statistic.ResultsA total of 17 studies involving 16485 patients were identified. Most studies had low risks of bias. Meta-analysis of all 17 studies revealed that CCM interventions significantly decreased HbA1c levels compared to usual care, with a mean difference (MD) of −0.21%, 95% CI −0.30,−0.13; Z = 5.07, p<0.00001. Larger effects were experienced among adults with baseline HbA1c ≥8% (MD −0.36%, 95% CI −0.51,−0.21; Z = 5.05, p<0.00001) and when four or more CCM elements were present in the interventions (MD −0.25%, 95% CI −0.35,−0.15; Z = 4.85, p<0.00001). Interventions with CCM decreased SBP (MD −2.93 mmHg, 95% CI −4.46,−1.40, Z = 3.75, p=0.0002) and DBP (MD −1.35 mmHg, 95% CI −2.05,−0.65, Z = 3.79, p=0.0002) compared to usual care but there was no impact on LDL cholesterol levels or BMI.ConclusionsCCM interventions, compared to usual care, improve glycaemic control among adults with type 2 diabetes in primary care, with greater reductions when the mean baseline HbA1c is ≥8% and with interventions containing four or more CCM elements.Systematic review registrationPROSPERO  CRD42021273959

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

12982_2022_119_Article_IEq51.gif

12982_2022_119_Article_IEq198.gif

12982_2022_119_Article_IEq197.gif

12982_2022_119_Article_IEq196.gif

12982_2022_119_Article_IEq195.gif

Fig. 1

12982_2022_119_Article_IEq192.gif

12982_2022_119_Article_IEq186.gif

12982_2022_119_Article_IEq45.gif

12982_2022_119_Article_IEq29.gif

12982_2022_119_Article_IEq24.gif

13690_2022_1004_Article_IEq3.gif