Improving diabetes care in general practice: randomized trial and prospective cohort study (DIANA)

The DIANA study included 1158 patients diagnosed with type 2 diabetes mellitus who were 18 years or older at baseline (93.7 % were older than 40 years). Study participants were recruited by their general practitioner (GP) in accordance with a standardized protocol between October 2008 and March 2010 in the Ludwigsburg-Heilbronn area situated in South-West Germany [1-3]. Study participants were re-examined 4, 7 and 10 years after baseline. In addition to the sociodemographic characteristics reported by patients, the GPs also filled questionnaires with questions about diabetes treatment and co-morbidities. In addition, blood samples and mortality data were collected at baseline, 4-, 7-, and 10-year follow-up.

Apart from the cohort study, a randomized controlled trial was conducted in a subpopulation of the DIANA study [4]. Patients were individually randomized into intervention (n = 103) and usual care group (n = 101). The trial investigated whether a patient-centered supportive counseling intervention comprising monthly telephone-based counseling sessions by practice nurses over 12 months improved diabetes-related medical and psycho-social outcomes above usual care in type 2 diabetes patients with poor glycemic control at baseline (HbA1c >7.5%) in a primary care setting. Although we found no beneficial effect of the supportive telephone counseling in terms of a reduction of HbA1c above usual care, our findings suggest some beneficial effects of the intervention on cardiovascular risk factors, quality of life and depression.

Publications:

1. Krämer HU, Raum E, Rüter G, Schöttker B, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H: Gender disparities in diabetes and coronary heart disease medication among patients with type 2 diabetes: results from the DIANA study. Cardiovasc Diabetol 2012, 11(1):88.
2. Raum E, Krämer HU, Rüter G, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H: Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2012, 97(3):377-384.
3. Anusruti A, Xuan Y, Gào X, Jansen EHJM, Laetsch DC, Brenner H, Schöttker B: Factors associated with high oxidative stress in patients with type 2 diabetes: a meta-analysis of two cohort studies. BMJ Open Diabetes Res Care 2020, 8(1).
4. Mons U, Raum E, Krämer HU, Rüter G, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H: Effectiveness of a supportive telephone counseling intervention in type 2 diabetes patients: randomized controlled study. PLoS One 2013, 8(10):e77954.