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

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

Abstract

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.

References

    1. J Clin Epidemiol. 2003 Feb;56(2):124-30
    1. BMJ. 2001 Oct 27;323(7319):970-5
    1. Arch Intern Med. 2010 Sep 27;170(17):1566-75
    1. N Engl J Med. 2008 Jun 12;358(24):2545-59
    1. BMC Fam Pract. 2009 May 06;10:30
    1. BMJ. 2009 May 26;338:b1870
    1. BMJ. 1998 Aug 8;317(7155):390-6
    1. Patient Educ Couns. 2009 Aug;76(2):174-80
    1. N Engl J Med. 2011 Mar 3;364(9):818-28
    1. Lancet. 2004 Jul 31-Aug 6;364(9432):423-8
    1. Diabetologia. 2012 Jun;55(6):1577-96
    1. BMJ. 1993 Mar 6;306(6878):630-4
    1. Lancet. 1998 Sep 12;352(9131):837-53
    1. Ann Intern Med. 2009 Jun 2;150(11):803-8
    1. Diabetes Care. 2006 Sep;29(9):1997-2002
    1. BMJ. 2007 Oct 20;335(7624):806-8
    1. JAMA. 2002 Oct 16;288(15):1909-14
    1. Diabetologia. 2006 Sep;49(9):2058-67
    1. N Engl J Med. 2008 Oct 9;359(15):1565-76
    1. Arch Intern Med. 2005 Jun 27;165(12):1410-9
    1. Lancet. 2011 Jul 9;378(9786):156-67
    1. Lancet. 2009 May 23;373(9677):1765-72
    1. Cochrane Database Syst Rev. 2001;(1):CD001481
    1. Lancet. 2011 Jul 9;378(9786):129-39
    1. JAMA. 2006 Jul 26;296(4):427-40
    1. N Engl J Med. 2009 Jan 8;360(2):129-39
    1. Scand J Public Health. 2011 Jul;39(7 Suppl):30-3
    1. BMC Public Health. 2009 May 12;9:136
    1. Arch Intern Med. 2011 Mar 14;171(5):453-9
    1. Neuroepidemiology. 2007;28(3):150-4
    1. Scand J Public Health. 2011 Jul;39(7 Suppl):26-9
    1. JAMA. 2002 Oct 9;288(14):1775-9
    1. N Engl J Med. 2008 Feb 7;358(6):580-91
    1. Manag Care Q. 1996 Spring;4(2):12-25
    1. N Engl J Med. 2008 Oct 9;359(15):1577-89
    1. Dan Med Bull. 2006 Nov;53(4):441-9
    1. N Engl J Med. 2008 Jun 12;358(24):2560-72
    1. BMJ. 1998 Sep 12;317(7160):703-13
    1. Lancet. 1999 Feb 20;353(9153):617-22
    1. Lancet. 2008 Jan 12;371(9607):117-25
    1. Diabetologia. 2010 Oct;53(10):2079-85

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