Interventions in the Delivery of Outpatient Diabetes Care: A systematic review of the literature 2001-2005

CONTEXT: Current practices of outpatient care for type 2 diabetes are not producing adequate patient-oriented outcomes according to the targets established by clinical research trials. OBJECTIVE: To systematically review the best evidence available about the care of diabetes in the outpatient setting. METHODS: The author searched both the PubMed and CINAHL databases for reports of randomized controlled trials and systematic reviews published in English between 2001-2005 that matched the MeSH terms "diabetes" and "outpatient". Articles were then narrowed based on both relevance and quality. Included studies reported patient-oriented outcomes (blood pressure, percent hemoglobin A1c, or blood lipid levels). Interventions were divided into those affecting the setting of care, affecting the process of care, or involving primarily education. RESULTS: Of441 identified articles, 19 met all criteria and were included. Intensive process interventions were effective and generally involved multifaceted case management. Educational interventions were effective in the short term, but benefits did not extend beyond the intervention term for any study. Setting interventions showed no significant benefit. CONCLUSIONS: The literature on this topic is still inconclusive and heterogeneous. The few interventions that showed benefit are highly resource-intensive, and for this reason have significant threats to broad applicability. Successful process interventions require cost-benefit studies to determine their widespread feasibility in varied settings. Neither setting nor education interventions show physiological benefits that justify their cost.Master of Public Healt