Meta-analysis of the effectiveness of chronic care management for diabetes

Investigating heterogeneity in outcomes

A.M.J. Elissen, L.M.G. Steuten, L.C. Lemmens, H.W. Drewes, K.M.M. Lemmens, J.A.C. Meeuwissen, C.A. Baan, H.J.M. Vrijhoef

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

Purpose 
The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management.
Methods 
Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult patients; and (3) interventions consisting of at least two components of the chronic care model (CCM). Systematic reviews were analysed descriptively; empirical studies were meta-analysed. Pooled effect measures were estimated using a meta-regression model that incorporated study quality, length of follow-up and number of intervention components as potential predictors of heterogeneity in effects.
Results 
Overall, reviews (n = 15) of diabetes care programmes report modest improvements in glycaemic control. Empirical studies (n = 61) show wide-ranging results on HbA1c, systolic blood pressure and guideline adherence. Differences between studies in methodological quality cannot explain this heterogeneity in effects. Variety in length of follow-up can explain (part of) the variability, yet not across all outcomes. Diversity in the number of included intervention components can explain 8–12% of the heterogeneity in effects on HbA1c and systolic blood pressure.
Conclusions 
The outcomes of chronic care management for diabetes are generally positive, yet differ considerably across trials. The most promising results are attained in studies with limited follow-up (<1 year) and by programmes including more than two CCM components. These factors can, however, explain only part of the heterogeneity in effectiveness between studies. Other potential sources of heterogeneity should be investigated to ensure implementation of evidence-based improvements in diabetes care.
Original languageEnglish
Pages (from-to)753-762
JournalJournal of Evaluation in Clinical Practice
Volume19
Issue number5
DOIs
Publication statusPublished - 2013

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Guideline Adherence
Diabetes Mellitus

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Elissen, A. M. J., Steuten, L. M. G., Lemmens, L. C., Drewes, H. W., Lemmens, K. M. M., Meeuwissen, J. A. C., ... Vrijhoef, H. J. M. (2013). Meta-analysis of the effectiveness of chronic care management for diabetes: Investigating heterogeneity in outcomes. Journal of Evaluation in Clinical Practice, 19(5), 753-762. https://doi.org/10.1111/j.1365-2753.2012.01817.x
Elissen, A.M.J. ; Steuten, L.M.G. ; Lemmens, L.C. ; Drewes, H.W. ; Lemmens, K.M.M. ; Meeuwissen, J.A.C. ; Baan, C.A. ; Vrijhoef, H.J.M. / Meta-analysis of the effectiveness of chronic care management for diabetes : Investigating heterogeneity in outcomes. In: Journal of Evaluation in Clinical Practice. 2013 ; Vol. 19, No. 5. pp. 753-762.
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abstract = "Purpose  The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management.Methods  Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult patients; and (3) interventions consisting of at least two components of the chronic care model (CCM). Systematic reviews were analysed descriptively; empirical studies were meta-analysed. Pooled effect measures were estimated using a meta-regression model that incorporated study quality, length of follow-up and number of intervention components as potential predictors of heterogeneity in effects.Results  Overall, reviews (n = 15) of diabetes care programmes report modest improvements in glycaemic control. Empirical studies (n = 61) show wide-ranging results on HbA1c, systolic blood pressure and guideline adherence. Differences between studies in methodological quality cannot explain this heterogeneity in effects. Variety in length of follow-up can explain (part of) the variability, yet not across all outcomes. Diversity in the number of included intervention components can explain 8–12{\%} of the heterogeneity in effects on HbA1c and systolic blood pressure.Conclusions  The outcomes of chronic care management for diabetes are generally positive, yet differ considerably across trials. The most promising results are attained in studies with limited follow-up (<1 year) and by programmes including more than two CCM components. These factors can, however, explain only part of the heterogeneity in effectiveness between studies. Other potential sources of heterogeneity should be investigated to ensure implementation of evidence-based improvements in diabetes care.",
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Meta-analysis of the effectiveness of chronic care management for diabetes : Investigating heterogeneity in outcomes. / Elissen, A.M.J.; Steuten, L.M.G.; Lemmens, L.C.; Drewes, H.W.; Lemmens, K.M.M.; Meeuwissen, J.A.C.; Baan, C.A.; Vrijhoef, H.J.M.

In: Journal of Evaluation in Clinical Practice, Vol. 19, No. 5, 2013, p. 753-762.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - Meta-analysis of the effectiveness of chronic care management for diabetes

T2 - Investigating heterogeneity in outcomes

AU - Elissen, A.M.J.

AU - Steuten, L.M.G.

AU - Lemmens, L.C.

AU - Drewes, H.W.

AU - Lemmens, K.M.M.

AU - Meeuwissen, J.A.C.

AU - Baan, C.A.

AU - Vrijhoef, H.J.M.

PY - 2013

Y1 - 2013

N2 - Purpose  The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management.Methods  Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult patients; and (3) interventions consisting of at least two components of the chronic care model (CCM). Systematic reviews were analysed descriptively; empirical studies were meta-analysed. Pooled effect measures were estimated using a meta-regression model that incorporated study quality, length of follow-up and number of intervention components as potential predictors of heterogeneity in effects.Results  Overall, reviews (n = 15) of diabetes care programmes report modest improvements in glycaemic control. Empirical studies (n = 61) show wide-ranging results on HbA1c, systolic blood pressure and guideline adherence. Differences between studies in methodological quality cannot explain this heterogeneity in effects. Variety in length of follow-up can explain (part of) the variability, yet not across all outcomes. Diversity in the number of included intervention components can explain 8–12% of the heterogeneity in effects on HbA1c and systolic blood pressure.Conclusions  The outcomes of chronic care management for diabetes are generally positive, yet differ considerably across trials. The most promising results are attained in studies with limited follow-up (<1 year) and by programmes including more than two CCM components. These factors can, however, explain only part of the heterogeneity in effectiveness between studies. Other potential sources of heterogeneity should be investigated to ensure implementation of evidence-based improvements in diabetes care.

AB - Purpose  The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management.Methods  Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult patients; and (3) interventions consisting of at least two components of the chronic care model (CCM). Systematic reviews were analysed descriptively; empirical studies were meta-analysed. Pooled effect measures were estimated using a meta-regression model that incorporated study quality, length of follow-up and number of intervention components as potential predictors of heterogeneity in effects.Results  Overall, reviews (n = 15) of diabetes care programmes report modest improvements in glycaemic control. Empirical studies (n = 61) show wide-ranging results on HbA1c, systolic blood pressure and guideline adherence. Differences between studies in methodological quality cannot explain this heterogeneity in effects. Variety in length of follow-up can explain (part of) the variability, yet not across all outcomes. Diversity in the number of included intervention components can explain 8–12% of the heterogeneity in effects on HbA1c and systolic blood pressure.Conclusions  The outcomes of chronic care management for diabetes are generally positive, yet differ considerably across trials. The most promising results are attained in studies with limited follow-up (<1 year) and by programmes including more than two CCM components. These factors can, however, explain only part of the heterogeneity in effectiveness between studies. Other potential sources of heterogeneity should be investigated to ensure implementation of evidence-based improvements in diabetes care.

U2 - 10.1111/j.1365-2753.2012.01817.x

DO - 10.1111/j.1365-2753.2012.01817.x

M3 - Review article

VL - 19

SP - 753

EP - 762

JO - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

SN - 1356-1294

IS - 5

ER -