A systematic review of diabetes disease management programs.

OBJECTIVE To systematically evaluate and synthesize published evidence regarding the effect of disease management programs for patients with diabetes mellitus on processes and outcomes of care. STUDY DESIGN Systematic literature review and meta-analysis. PATIENTS AND METHODS Computerized databases were searched for English-language controlled studies assessing the effect of diabetes disease management programs published from 1987 to 2001. Two reviewers extracted study data using a structured abstraction form. Pooled estimates of program effects on glycated hemoglobin were calculated using an empirical Bayes model. RESULTS The pooled estimate of program effects on glycated hemoglobin was a 0.5-percentage point reduction (95% confidence interval, 0.3 to 0.6 percentage points), a modest but significant improvement. Evidence also supports program benefits in improving screening for retinopathy and foot lesions. CONCLUSIONS Diabetes disease management programs can improve glycemic control to a modest extent and can increase screening for retinopathy and foot complications. Further efforts will be required to create more effective disease management programs for patients with diabetes mellitus.