Il modello di disease management “Gestione Integrata”: l’esperienza in una popolazione afferente l’ambulatorio di Malattie del Metabolismo e Diabetologia dell’AOU S.Luigi Orbassano nel periodo 2008-2014

[Machine translation] The Integrated Management (GI) implemented in Piedmont since September 2008 requires that the metabolically stable and uncomplicated type 2 diabetic person (DT2) is managed by the General Practitioner (MMG) according to a PDTA shared with the Specialists of the Diabetological Center (CD). Study Design: Compare two populations with DT2 enrolled from 1/9/2008 to 31/12/2014: Group (A) followed in GI (No. 1326), Group (B) (n = 3494) in intensive follow-up in the CD. Data were expressed as m ± ds; statistical analysis was conducted with Student's t for paired or independent data. As of 31/12/2015, in both groups, there was a significant (< 0.001) and consensual (NS) improvement in the indicators studied compared to baseline, with the exception of HbA1c, which improved in both groups (more in B than in A: p < 0.011). Conclusions: i) metabolic parameters improve in both groups; the greater reduction in HbA1c in B is probably the effect of the worst initial compensation in a population with greater disease severity; ii) the GI project is functional and safe for the patient because there has been an improvement in metabolic parameters over the years; iii) our work has demonstrated that on an organizational-management level, the GI, if applied correctly, allows the reduction of inappropriate flow to the DCs of clinically stable patients, who do not need of a close specialist assessment.