Clinical and behavioral impact of implementing community-based diabetes disease management in Japan

Background: Treatment for type 2 diabetes mellitus consists of dietary and exercise therapy, administration of oral hypoglycemic agents and insulin treatment for each stage. Compliance/adherence by patients to drug therapy and self care in their daily lives, not only in the stage of dietary and exercise therapy, but also after the start of drug therapy, are important factors. Disease management supporting self care may have a positive influence on the clinical management of diabetes. This study examined the effects of a disease management program implemented in the Yasugi-Nogi region of Shimane prefecture of Japan on clinical and behavioral aspects for type 2 diabetes in which intervention was implemented primarily by healthcare institutions. Methods: The participants of this study consisted of 316 patients with diabetes. Routine care was provided based on the standards of care and standardized educational materials. Intervention was implemented by having patients set attainable goals with physicians and allied health professionals based on evaluations of their own lifestyle risks, and then using a diary to evaluate whether or not those goals were able to be attained. Evaluations were based on assessments of clinical parameters, patient behavior and health-related quality of life (HR-QOL). Results: The results showed that significant improvement was observed in diastolic pressure, glycosylated hemoglobin (HbA1c) and triglyceride levels, regardless of the use of a diary. Improvement was also observed in diet and knowledge of diabetes, and improvement in HR-QOL was also observed, as assessed using the Problem Area in Diabetes Survey. A study of factors having an effect on the efficacy of disease management was conducted by focussing on HbA1c, diet score, knowledge score, and HR-QOL with respect to the type of treatment following intervention, diary use, and observence of physician guidance. In particular, the improvement in diet score was significantly better in the diary-user group. Conclusion: The program employed in this region makes use of an easily deployable intervention method targeting diabetic patients with comparatively mild symptoms; therefore it is believed to be a realistic method for use as a disease management model led by physicians in regions where healthcare institutions play a central role.