Zi Zeng , Ting Shuai , Li-Juan Yi , Yan Wang , Guo-Min Song
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The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin (HbA<sub>1c</sub>), systolic blood pressure (SBP), diastolic blood pressure (DBP), and low-density lipoprotein (LDL).</p></div><div><h3>Methods</h3><p>Databases including PubMed, Embase, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), VIP, Wan Fang and the Chinese Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCTs) dating as late as Jan, 2015. Reference sections of the included studies were also searched.</p></div><div><h3>Results</h3><p>Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported HbA<sub>1c</sub> as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. The pooled results indicated that statistically significant improvements in HbA<sub>1c</sub> (MD = −0.35, 95% <em>CI</em> (−0.68, −0.02), <em>P</em> = 0.04) and LDL levels (MD = −2.49, 95% <em>CI</em> (−4.04, −0.93), <em>P</em> = 0.002) were associated with the case management group compared with control group; however, no statistically significant differences in DBP (MD = −0.08, 95% <em>CI</em> (−0.68, 0.52), <em>P</em> = 0.8) and SBP (MD = −0.96, 95% <em>CI</em> (−5.77, 3.84), <em>P</em> = 0.69) were observed.</p></div><div><h3>Conclusions</h3><p>Case management was effective in improving HbA<sub>1c</sub> and LDL levels in patients with type 2 diabetes mellitus. Although no statistically significant differences in DBP and SBP between the case management group and the control group were observed, further research is required to draw a conclusion about the effect of managed care on these outcomes. Based on this meta-analysis of clinical trials, we conclude that case management offers an effective clinical method for the treatment of type 2 diabetes.</p></div>","PeriodicalId":57172,"journal":{"name":"Frontiers of Nursing","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cnre.2016.06.008","citationCount":"12","resultStr":"{\"title\":\"Effect of case management on patients with type 2 diabetes mellitus: a meta-analysis\",\"authors\":\"Zi Zeng , Ting Shuai , Li-Juan Yi , Yan Wang , Guo-Min Song\",\"doi\":\"10.1016/j.cnre.2016.06.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requires the incorporation of information pertaining to patient evaluation, treatment planning, referrals, and follow-up care to ensure that payment for services is received and that care is ongoing and comprehensive. The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin (HbA<sub>1c</sub>), systolic blood pressure (SBP), diastolic blood pressure (DBP), and low-density lipoprotein (LDL).</p></div><div><h3>Methods</h3><p>Databases including PubMed, Embase, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), VIP, Wan Fang and the Chinese Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCTs) dating as late as Jan, 2015. Reference sections of the included studies were also searched.</p></div><div><h3>Results</h3><p>Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported HbA<sub>1c</sub> as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. 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引用次数: 12
摘要
病例管理是一个术语，用于描述医生或其他卫生保健专业人员为确保患者所需医疗服务的协调而进行的活动。管理式护理需要纳入有关患者评估、治疗计划、转诊和后续护理的信息，以确保收到服务付款，并确保护理是持续和全面的。本综述的目的是评估病例管理对2型糖尿病患者的疗效，包括糖化血红蛋白(HbA1c)、收缩压(SBP)、舒张压(DBP)和低密度脂蛋白(LDL)。方法检索PubMed、Embase、Web of Science、Cochrane Library、中国知网(CNKI)、维普(VIP)、万方、中国生物医学文献数据库(CBM)等数据库，检索截止至2015年1月的随机对照试验(RCTs)。还检索了纳入研究的参考文献。结果本分析纳入12项研究，涉及11项随机对照试验，共评估了4000例患者。12项研究中有两项评估的是同一项随机对照试验。12项研究中有7项报告了HbA1c作为结果，3项研究报告了收缩压、舒张压和低密度脂蛋白水平的变化作为结果。合并结果显示，与对照组相比，病例管理组HbA1c (MD = - 0.35, 95% CI (- 0.68， - 0.02)， P = 0.04)和LDL水平(MD = - 2.49, 95% CI (- 4.04， - 0.93)， P = 0.002)的改善具有统计学意义;然而，舒张压(MD = - 0.08, 95% CI (- 0.68, 0.52)， P = 0.8)和收缩压(MD = - 0.96, 95% CI (- 5.77, 3.84)， P = 0.69)差异无统计学意义。结论病例管理可有效改善2型糖尿病患者的HbA1c和LDL水平。虽然病例管理组和对照组之间的舒张压和收缩压没有统计学上的显著差异，但需要进一步的研究来得出管理式护理对这些结果的影响的结论。基于临床试验的荟萃分析，我们得出结论，病例管理为治疗2型糖尿病提供了一种有效的临床方法。
Effect of case management on patients with type 2 diabetes mellitus: a meta-analysis
Background
Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requires the incorporation of information pertaining to patient evaluation, treatment planning, referrals, and follow-up care to ensure that payment for services is received and that care is ongoing and comprehensive. The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), and low-density lipoprotein (LDL).
Methods
Databases including PubMed, Embase, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), VIP, Wan Fang and the Chinese Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCTs) dating as late as Jan, 2015. Reference sections of the included studies were also searched.
Results
Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported HbA1c as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. The pooled results indicated that statistically significant improvements in HbA1c (MD = −0.35, 95% CI (−0.68, −0.02), P = 0.04) and LDL levels (MD = −2.49, 95% CI (−4.04, −0.93), P = 0.002) were associated with the case management group compared with control group; however, no statistically significant differences in DBP (MD = −0.08, 95% CI (−0.68, 0.52), P = 0.8) and SBP (MD = −0.96, 95% CI (−5.77, 3.84), P = 0.69) were observed.
Conclusions
Case management was effective in improving HbA1c and LDL levels in patients with type 2 diabetes mellitus. Although no statistically significant differences in DBP and SBP between the case management group and the control group were observed, further research is required to draw a conclusion about the effect of managed care on these outcomes. Based on this meta-analysis of clinical trials, we conclude that case management offers an effective clinical method for the treatment of type 2 diabetes.
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