PRODIACOR: Educative interventions improve clinical and metabolic outcomes and optimise treatment costs in an Argentinean population with type 2 diabetes.

PFIRTER G; LAPERTOSA S; VILLAGRA M; CAPORALE JE; GONZALEZ C; CLARK JR C; GAGLIARDINO JJ

Estocolmo

Congreso; 46th EASD Annual Meeting; 2010

EASD

Background and Aim: PRODIACOR is a randomized controlled clinical trial implemented in a primary care setting (Corrientes city, Argentina) aimed at measuring the impact of educative interventions upon quality of care of people with type 2 diabetes (T2DM) and to measure the cost-effectiveness of such interventions. Materials and Methods: 36 primary care physicians and 468 persons with T2DM were randomized at physician level and allocated to 4 groups: 1) patients but not physicians received an education programme, 2) physicians but not patients received an education programme, 3) both physicians and patients received an education programme, and 4) control group (physicians/patients received no education but education material and data feedback). Patients from all groups received complete coverage of drugs and supplies; clinical, metabolic and therapeutic indicators were recorded. Educated physicians attended 4 interactive theoretical-practical modules and received a manual with all the algorithms for diagnosis, control and treatment of T2DM. Educated patient attended 4 weekly teaching units and a reinforcing session after 6 weeks, with a focus at improving health behaviour. Educational material included an individual log-booklet to record the self-monitored data (blood glucose and body weight) and a book with the main contents of the programme. Every patient – irrespective of his group allocation –  received a check-book which served 2 purposes: a) as a reminder system for medical visits and laboratory test performance, and b) as a data collection system (record of laboratory tests, consultations or prescriptions for drugs or devices). Physicians monitored and recorded clinical data and data collection was monitored twice a year. We currently report baseline and 3-year follow-up data. Results: The population age was (Mean±SD) 63±9 years (66% female) and diabetes duration was 10±8 years. After the 3-year follow up we recorded no significant changes in BMI but significant improvements (p<0.001) in all groups in systolic (142±17 vs. 134±15 mmHg) and diastolic (87±11 vs. 80± 9 mmHg) blood  pressure, FBG (8.0±2.5 vs. 7.2±2.2 mmol/L), HbA1c (7.8±1.5 vs. 7.1±0.8%) and total cholesterol (4.7±0.9 vs. 4.4±0.7. mmol/L). All these changes were significantly larger in the intervention groups. The percentage of patients at target for all these parameters was significantly (p<0.01) larger in these groups. In the educated groups, we also recorded a significant increment in combined against oral monotheraphy (42 vs. 30%) and insulin use (15 vs. 9%). Drug consumption and strips for blood glucose represented 64 and 83% ot the total care cost at baseline and 3-year follow up, respectively. This cost increased (113%) in the control group while it significantly decreased (11 to 20%) in the intervention groups, particularly in the patient/physician educated group. Conclusion: Educative interventions implemented at a primary care level to people with T2DM improved the clinical and metabolic outcomes and optimized the use of drugs for DM and other associated cardiovascular risks factors, decreasing the total costs. Supported by NovoNordisk International Affairs.