Self-management Education by Group Care Reduces Cardiovascular Risk in Patients With Type 2 Diabetes: Analysis of the ROMEO Clinical Trial

Treatment of type 2 diabetes includes lifestyle and pharmacological interventions. Drugs are marginally effective in achieving glycemic targets and reducing cardiovascular (CV) events, whereas intervention on lipids, blood pressure, and lifestyle is more effective. Rethink Organisation to iMprove Education and Outcomes (ROMEO) (ISRCTN19509463), a 4-year multicenter randomized trial, showed that patients with type 2 diabetes on group care (GC), a previously described systemic self-management education model, improved body weight, HbA1c, HDL and LDL cholesterol, blood pressure, quality of life, and health behaviors, compared with patients on usual care and similar pharmacological treatment (1). The ROMEO data set was fed into three risk engines, Framingham (2), UK Prospective Diabetes Study (UKPDS) (3), and CUORE (4), to verify if GC modifies CV risk scores.A total of 815 non-insulin–treated patients aged <80 years were allocated to either GC or traditional care (controls). Risk calculations were performed at baseline and throughout the 4 years of the trial in 466 patients (257 on GC and 209 controls) who completed ROMEO. Reasons for dropping out were reported (5), and …