Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)
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Socio-demographic determinants and effect of structured personal diabetes care : a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP). / Heltberg, Andreas; Siersma, Volkert; Andersen, John Sahl; Ellervik, Christina; Brønnum-Hansen, Henrik; Kragstrup, Jakob; Olivarius, Niels de Fine.
I: B M C Endocrine Disorders, Bind 17, 75, 08.12.2017, s. 1-11.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Socio-demographic determinants and effect of structured personal diabetes care
T2 - a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)
AU - Heltberg, Andreas
AU - Siersma, Volkert
AU - Andersen, John Sahl
AU - Ellervik, Christina
AU - Brønnum-Hansen, Henrik
AU - Kragstrup, Jakob
AU - Olivarius, Niels de Fine
PY - 2017/12/8
Y1 - 2017/12/8
N2 - Background: We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes.Methods: The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis.Results: Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60–0.85) and of 1.07 (95%CI: 0.77–1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care.Conclusion: Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted.Trial registration: ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).
AB - Background: We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes.Methods: The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis.Results: Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60–0.85) and of 1.07 (95%CI: 0.77–1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care.Conclusion: Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted.Trial registration: ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).
KW - Type 2 diabetes mellitus
KW - Social inequalities
KW - Intervention
KW - Clinical outcomes
U2 - 10.1186/s12902-017-0227-x
DO - 10.1186/s12902-017-0227-x
M3 - Journal article
C2 - 29216868
VL - 17
SP - 1
EP - 11
JO - BMC Endocrine Disorders
JF - BMC Endocrine Disorders
SN - 1472-6823
M1 - 75
ER -
ID: 188194183