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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| Authors: | Andreas Heltberg Volkert Siersma John Sahl Andersen Christina Ellervik Henrik Brønnum-Hansen Jakob Kragstrup Niels de Fine Olivarius |
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| Affiliation: | 1.Section of General Practice, Institute of Public Health, Faculty of Health Sciences,Copenhagen,Denmark;2.The Research Unit for General Practice, Department of Public Health,University of Copenhagen,Copenhagen,Denmark;3.Department of Production, Research, and Innovation,Sor?,Denmark;4.Department of Laboratory Medicine,Boston Children’s Hospital Study,Boston,USA;5.Department of Clinical Medicine, Faculty of Health and Medical Sciences,University of Copenhagen,Copenhagen,Denmark;6.Department of Social Medicine,University of Copenhagen,Copenhagen,Denmark |
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| Abstract: | BackgroundWe investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes.MethodsThe 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.ResultsStructured 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.ConclusionStructured 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 registrationClinicalTrials.gov registration no. NCT01074762 (February 24, 2010). |
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