Meta-analysis of the effectiveness of chronic care management for diabetes: investigating heterogeneity in outcomes

Arianne M. J. Elissen*, Lotte M. G. Steuten, Lidwien C. Lemmens, Hanneke W. Drewes, Karin M. M. Lemmens, Jolanda A. C. Meeuwissen, Caroline A. Baan, Hubertus J. M. Vrijhoef

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management. Methods Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult patients; and (3) interventions consisting of at least two components of the chronic care model (CCM). Systematic reviews were analysed descriptively; empirical studies were meta-analysed. Pooled effect measures were estimated using a meta-regression model that incorporated study quality, length of follow-up and number of intervention components as potential predictors of heterogeneity in effects. Results Overall, reviews (n=15) of diabetes care programmes report modest improvements in glycaemic control. Empirical studies (n=61) show wide-ranging results on HbA1c, systolic blood pressure and guideline adherence. Differences between studies in methodological quality cannot explain this heterogeneity in effects. Variety in length of follow-up can explain (part of) the variability, yet not across all outcomes. Diversity in the number of included intervention components can explain 8-12% of the heterogeneity in effects on HbA1c and systolic blood pressure. Conclusions The outcomes of chronic care management for diabetes are generally positive, yet differ considerably across trials. The most promising results are attained in studies with limited follow-up (
Original languageEnglish
Pages (from-to)753-762
JournalJournal of Evaluation in Clinical Practice
Issue number5
Publication statusPublished - Oct 2013


  • chronic disease management
  • diabetes mellitus
  • health services research
  • quality improvement


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