Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)
| Autor: | N. de Fine Olivarius, Henning Beck-Nielsen, Volkert Siersma, Lars J. Hansen |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Multivariate analysis Endocrinology Diabetes and Metabolism Myocardial Infarction MEDLINE Any diabetes-related endpoint Type 2 diabetes law.invention Diabetes Complications Randomized controlled trial Risk Factors law Diabetes mellitus Internal Medicine medicine Humans Registries Mortality Triglycerides Aged Personal care business.industry Multifactorial intervention Chronic care model Middle Aged medicine.disease Self Care Stroke Myocardial infarction Treatment Outcome Diabetes Mellitus Type 2 Family medicine Multivariate Analysis General practice Physical therapy Female Observational study business Follow-Up Studies |
| Zdroj: | Hansen, L J, Siersma, V D, Beck-Nielsen, H & de Fine Olivarius, N 2013, ' Structured personal care of type 2 diabetes : a 19 year follow-up of the study Diabetes Care in General Practice (DCGP) ', Diabetologia, vol. 56, no. 6, pp. 1243-1253 . https://doi.org/10.1007/s00125-013-2893-1 |
| ISSN: | 1432-0428 0012-186X |
| DOI: | 10.1007/s00125-013-2893-1 |
| Popis: | Aims/hypothesis: This study is a 19 year observational follow-up of a pragmatic open multicentre cluster-randomised controlled trial of 6 years of structured personal diabetes care starting from diagnosis. Methods: A total of 1,381 patients aged ≥40 years and newly diagnosed with type 2 diabetes were followed up in national registries for 19 years. Clinical follow-up was at 6 and 14 years after diabetes diagnosis. The original 6 year intervention included regular follow-up and individualised goal setting, supported by prompting of doctors, clinical guidelines, feedback and continuing medical education (ClinicalTrials.gov NCT01074762). The registry-based endpoints were: incidence of any diabetes-related endpoint; diabetes-related death; all-cause mortality; myocardial infarction (MI); stroke; peripheral vascular disease; and microvascular disease. Results: At 14 year clinical follow-up, group differences in risk factors from the 6 year follow-up had levelled out, although the prevalence of (micro)albuminuria and level of triacylglycerols were lower in the intervention group. During 19 years of registry-based monitoring, all-cause mortality was not different between the intervention and comparison groups (58.9 vs 62.3 events per 1,000 patient-years, respectively; for structured personal care, HR 0.94, 95% CI 0.83, 1.08, p = 0.40), but a lower risk emerged for fatal and non-fatal MI (27.3 vs 33.5, HR 0.81, 95% CI 0.68, 0.98, p = 0.030) and any diabetes-related endpoint (69.5 vs 82.1, HR 0.83, 95% CI 0.72, 0.97, p = 0.016). These differences persisted after extensive multivariable adjustment. Conclusions/interpretation: In concert with features such as prompting, feedback, clinical guidelines and continuing medical education, individualisation of goal setting and drug treatment may safely be applied to treat patients newly diagnosed with type 2 diabetes to lower the risk of diabetes complications. |
| Databáze: | OpenAIRE |
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