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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Striving for the impossible dream: A community-based multi-practice collaborative model of diabetes management
Diabetic Medicine, Volume 27, No. 2, Year 2010
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Description
Aims In 1994 the Centre for Diabetes and Endocrinology (CDE) based in Johannesburg, South Africa established a novel community-based capitation and risk-sharing model for diabetes management. We here describe the model and present a recent survey of the performance/outcomes of this unique diabetes care programme. Methods Data on 17 043 patients managed by the CDE Diabetes Management Programme at its Centre and its 262 affiliated Centres were analysed from its national database. From this total cohort, 1520 Type 1 and 8026 Type 2 diabetes patients have been in the Programme for > 5 years. The 5-year outcome data on hospital admission rates, glycaemic control (HbA
1c
), and microvascular complication rates were assessed in this subgroup of patients. Results Major reductions in hospital admission rates for both acute metabolic emergencies and all causes (40% overall) were achieved in patients enrolled onto the Diabetes Management Programme. The mean HBA
1c
on enrolment was 9.2% for subjects with Type 1 and 8.8% for those with Type 2 diabetes. After 1 year, mean HbA
1c
fell to 7.6% and 7.3% for the Type 1 and Type 2 subjects, respectively. At 5 years the HbA
1c
remained similar at 7.7% for the Type 1 subjects and 7.4% for the Type 2 subjects, demonstrating sustained improvement. Progression of microvascular complications appears to have been delayed. Conclusions This managed care model of diabetes care in the context of the South African Private Health Care System achieved long-term improvement in glycaemic control and all-cause hospital admission rates. This may be due to the cost-containment being in the hands of the treating doctor, supported by an annual training programme. This programme is based on an individualized and holistic approach encompassing intensive patient education to facilitate self-empowerment and including prompting for the management of risk factors. © 2010 Diabetes UK.
Authors & Co-Authors
Distiller, Lawrence A.
South Africa, Johannesburg
Centre for Diabetes and Endocrinology
South Africa, Houghton
Saxonwold
Brown, M. A.
South Africa, Johannesburg
Centre for Diabetes and Endocrinology
Joffe, Barry Isaac
South Africa, Johannesburg
Centre for Diabetes and Endocrinology
Kramer, Brian
South Africa, Johannesburg
Centre for Diabetes and Endocrinology
Statistics
Citations: 43
Authors: 4
Affiliations: 2
Identifiers
Doi:
10.1111/j.1464-5491.2009.02907.x
ISSN:
07423071
e-ISSN:
14645491
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa