Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study.
Doctor–patient relationship
Type 2 diabetes
epidemiology
patient experience
primary care
remission
Journal
Family practice
ISSN: 1460-2229
Titre abrégé: Fam Pract
Pays: England
ID NLM: 8500875
Informations de publication
Date de publication:
29 03 2021
29 03 2021
Historique:
pubmed:
13
9
2020
medline:
26
10
2021
entrez:
12
9
2020
Statut:
ppublish
Résumé
Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01). Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
Sections du résumé
BACKGROUND
Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed.
OBJECTIVE
To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up.
METHODS
A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes.
RESULTS
Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01).
CONCLUSION
Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
Identifiants
pubmed: 32918549
pii: 5904798
doi: 10.1093/fampra/cmaa086
pmc: PMC8006762
doi:
Banques de données
ISRCTN
['ISRCTN86769081']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
141-146Subventions
Organisme : Department of Health
ID : RP-PG-0606-1259
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12015/4
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0001164
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Department of Health
ID : DRF-2015-08-027
Pays : United Kingdom
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press.
Références
Drug Intell Clin Pharm. 1985 Apr;19(4):246-51
pubmed: 2861072
Fam Pract. 2007 Jun;24(3):245-51
pubmed: 17493954
BMJ Open. 2017 Apr 4;7(4):e012805
pubmed: 28377390
Lancet. 2008 Oct 18;372(9647):1385-93
pubmed: 18823658
Lancet. 2016 Jun 4;387(10035):2323-2330
pubmed: 27059888
PLoS One. 2013 Dec 30;8(12):e83948
pubmed: 24386313
Lancet. 2018 Feb 10;391(10120):541-551
pubmed: 29221645
Diabet Med. 2015 Sep;32(9):1149-55
pubmed: 25683066
Patient Educ Couns. 2003 Sep;51(1):17-28
pubmed: 12915276
Diabetes Care. 2016 May;39(5):808-15
pubmed: 27002059
Fam Pract. 2005 Jun;22(3):328-34
pubmed: 15772120
Health Expect. 2006 Mar;9(1):25-36
pubmed: 16436159
JAMA. 2012 Dec 19;308(23):2489-96
pubmed: 23288372
Lancet. 2016 Nov 19;388(10059):2492-2500
pubmed: 27789061
Diabetes Care. 2013 Oct;36(10):3054-61
pubmed: 23949558
BMC Public Health. 2009 May 12;9:136
pubmed: 19435491
Pharmacoeconomics. 1999 Dec;16(6):599-603
pubmed: 10724789
Lancet. 2012 Nov 17;380(9855):1741-8
pubmed: 23040422
BMC Public Health. 2011 Apr 04;11:211
pubmed: 21463520
J Med Internet Res. 2013 Jul 02;15(7):e131
pubmed: 23819959
BMJ. 2014 Nov 11;349:g6034
pubmed: 25389136
J Altern Complement Med. 2005 Aug;11(4):591-600
pubmed: 16131282
Br J Gen Pract. 2018 Sep;68(674):e646-e653
pubmed: 30104329
Ann Fam Med. 2004 Nov-Dec;2(6):595-608
pubmed: 15576546
Scand J Prim Health Care. 1997 Sep;15(3):118-22
pubmed: 9323777
Lancet. 2011 Jul 9;378(9786):156-67
pubmed: 21705063
Health Expect. 2017 Dec;20(6):1218-1227
pubmed: 28245085
Diabet Med. 2020 Apr;37(4):681-688
pubmed: 31479535
Br J Gen Pract. 2016 Jan;66(642):e47-52
pubmed: 26541182
N Engl J Med. 2013 Jul 11;369(2):145-54
pubmed: 23796131
BMC Fam Pract. 2013 May 31;14:72
pubmed: 23725212
Fam Pract. 2004 Dec;21(6):699-705
pubmed: 15528286
Arch Intern Med. 2006 Feb 27;166(4):431-6
pubmed: 16505263
Br J Gen Pract. 1992 Nov;42(364):454-8
pubmed: 1472390
BMJ. 2014 Oct 31;349:g6518
pubmed: 25361843
BMJ. 2017 Sep 13;358:j4030
pubmed: 28903916