A Cochrane review [Abstract] 1 included 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412 161 participants. Many different stragies were used: case management, team changes, electronic patient registry, facilitated relay of clinical information, continuous quality improvement (system targeted); audit and feedback, clinician education, clinician reminders, financial incentives (provider targeted); patient education, promotion of self-management, patient reminders (patient-targeted). The effects of individual strategies were modest. Combining case management, team changes, patient education, and promotion of self-management gave the best results for lowering the HbA1c, and systolic blood pressure: with lower baseline of HbA1c under 8.3%, the absolute mean difference was -0.25 (-0.36 to -0.13) and with baseline HbA1c over 8.3% the mean difference was -0.67 (-0.82 to -0.53).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concelament, incomplete outcome data, selective reporting in half of the sudies).
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