Please use this identifier to cite or link to this item: https://doi.org/10.1186/s13643-022-02117-w
Title: Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis
Authors: Goh, Lay Hoon 
Siah, Chiew Jiat Rosalind 
Tam, Wilson Wai San 
Tai, E Shyong 
Young, Doris Yee Ling 
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Chronic Care Model
Chronic disease
Disease management
Meta-analysis
Patient care team
Self-management
Systematic review
Type 2 diabetes
RANDOMIZED CONTROLLED-TRIAL
MULTIDISCIPLINARY RISK-ASSESSMENT
DISEASE-MANAGEMENT PROGRAMS
IMPROVING PRIMARY-CARE
QUALITY-OF-LIFE
CHRONIC ILLNESS
CARDIOVASCULAR RISK
CLINICAL-OUTCOMES
DECISION-SUPPORT
GLYCEMIC CONTROL
Issue Date: 15-Dec-2022
Publisher: BMC
Citation: Goh, Lay Hoon, Siah, Chiew Jiat Rosalind, Tam, Wilson Wai San, Tai, E Shyong, Young, Doris Yee Ling (2022-12-15). Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis. SYSTEMATIC REVIEWS 11 (1). ScholarBank@NUS Repository. https://doi.org/10.1186/s13643-022-02117-w
Abstract: Background: Mixed evidence exists regarding the effectiveness of the Chronic Care Model (CCM) with patient outcomes. The aim of this review is to examine the effectiveness of CCM interventions on hemoglobin A1c (HbA1c), systolic BP (SBP), diastolic BP (DBP), LDL cholesterol and body mass index (BMI) among primary care adults with type 2 diabetes. Methods: PubMed, Embase, CINAHL, Cochrane Central Registry of Controlled Trials, Scopus and Web of Science were searched from January 1990 to June 2021 for randomized controlled trials (RCTs) comparing CCM interventions against usual care among adults with type 2 diabetes mellitus in primary care with HbA1c, SBP, DBP, LDL cholesterol and BMI as outcomes. An abbreviated search was performed from 2021 to April 2022. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction and Cochrane risk of bias assessment. Two reviewers independently extracted the data. Meta-analysis was performed using Review Manager software. Heterogeneity was evaluated using χ2 and I2 test statistics. Overall effects were evaluated using Z statistic. Results: A total of 17 studies involving 16485 patients were identified. Most studies had low risks of bias. Meta-analysis of all 17 studies revealed that CCM interventions significantly decreased HbA1c levels compared to usual care, with a mean difference (MD) of −0.21%, 95% CI −0.30, −0.13; Z = 5.07, p<0.00001. Larger effects were experienced among adults with baseline HbA1c ≥8% (MD −0.36%, 95% CI −0.51, −0.21; Z = 5.05, p<0.00001) and when four or more CCM elements were present in the interventions (MD −0.25%, 95% CI −0.35, −0.15; Z = 4.85, p<0.00001). Interventions with CCM decreased SBP (MD −2.93 mmHg, 95% CI −4.46, −1.40, Z = 3.75, p=0.0002) and DBP (MD −1.35 mmHg, 95% CI −2.05, −0.65, Z = 3.79, p=0.0002) compared to usual care but there was no impact on LDL cholesterol levels or BMI. Conclusions: CCM interventions, compared to usual care, improve glycaemic control among adults with type 2 diabetes in primary care, with greater reductions when the mean baseline HbA1c is ≥8% and with interventions containing four or more CCM elements. Systematic review registration: PROSPERO CRD42021273959
Source Title: SYSTEMATIC REVIEWS
URI: https://scholarbank.nus.edu.sg/handle/10635/236318
ISSN: 2046-4053
DOI: 10.1186/s13643-022-02117-w
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