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Outcome of one-year of specialist care of patients with type 2 diabetes: a multi-center prospective survey (JDDM 2).

OBJECTIVE
Specialist care is reportedly associated with favorable therapeutic results, although detailed outcomes of recent large-scale prospective surveys of specialist care have yet to be published. The goal of this study was to elucidate the effects of one year's specialist care on the management of type 2 diabetes.


PATIENTS AND METHODS
A multi-centered, prospective observational study was undertaken. 754 type 2 diabetes patients, who made their first visit to one of eleven participating outpatient clinics specializing in diabetes care, were enrolled. Routine structured diabetes care according to established guideline, including diabetes self-management education, was provided to all patients at each clinic visit. Parameters relating to glycemic control, serum lipids, blood pressure, patient follow-up status and others were followed for twelve months.


RESULTS
The HbA(1C) level had improved significantly from 8.4+/-2.2% at baseline to 6.8+/-1.2% after six months and was 7.0+/-1.3% after twelve months (mean+/-SD). The higher the baseline HbA(1C) level, the greater the subsequent improvement. Moreover, the most dramatic improvements in HbA(1C) levels were seen within the first three months. The proportion of patients satisfying all of the therapeutic goals was extremely low at baseline and remained at less than 10% after twelve months of specialist care.


CONCLUSIONS
Diabetic patients under specialist care experienced substantial improvement, especially in glycemic control, as early as a few months after the first visit. However, 35 percent of patients dropped out during the 12-month study period and this is one area that needs to be improved.