Dr. Tricco said the findings of the study could help physicians decide which patients would benefit from which programs. Those who are not controlling their diabetes well, for example, might benefit from some of the more costly programs, such as team changes and case management. Yet that might not be a good use of resources for patients who are managing their illness well.

Overall, the use of quality improvement strategiesclinical reminders, clinical education. patient behavior, patient education-- resulted in a 0.37 per cent reduction of HbA1c after an average follow-up of one year. The meta-analysis did not find a statistically significant improvement in the use of statins (drugs that reduce cholesterol), hypertension reduction or smoking cessation. The interventions did play an important role in increasing the use of aspirin and antihypertensive medication over a median follow-up of 13 months. They also were associated with an increase in retinopathy (inflammation of the eye), screening, screening for renal disease and foot screening over a median follow-up of 12 months.

Dr. Tricco said wide implementation of such strategies could have important be
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