Journal Article

Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

Hansen, L. J., Siersma, V., Beck-Nielsen, H., de Fine Olivarius, N.

2013

Overview

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.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adult / Aged / Biological and medical sciences / Cardiology. Vascular system / Clinical practice guidelines / Consent / Coronary heart disease / Diabetes / Diabetes Complications - diagnosis / Diabetes Mellitus, Type 2 - mortality / Diabetes Mellitus, Type 2 - therapy / Diabetes. Impaired glucose tolerance / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / Follow-Up Studies / Goal setting / Heart / Heart attacks / Human Physiology / Humans / Internal Medicine / Intervention / Male / Medical education / Medical sciences / Medicine / Medicine & Public Health / Mental disorders / Metabolic Diseases / Middle Aged / Mortality / Multivariate Analysis / Myocardial Infarction - complications / Myocardial Infarction - diagnosis / Myocarditis. Cardiomyopathies / Neurology / Patients / Personal grooming / Primary care / Registries / Risk Factors / Self Care / Time Factors / Treatment Outcome / Triglycerides - blood / Vascular diseases and vascular malformations of the nervous system