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)
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12902-017-0227-x |
| _version_ | 1818320565363015680 |
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| author | Andreas Heltberg Volkert Siersma John Sahl Andersen Christina Ellervik Henrik Brønnum-Hansen Jakob Kragstrup Niels de Fine Olivarius |
| author_facet | Andreas Heltberg Volkert Siersma John Sahl Andersen Christina Ellervik Henrik Brønnum-Hansen Jakob Kragstrup Niels de Fine Olivarius |
| author_sort | Andreas Heltberg |
| collection | DOAJ |
| description | Abstract 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). |
| first_indexed | 2024-12-13T10:27:02Z |
| format | Article |
| id | doaj.art-9a502c0c4a5247a887d412b2bc0e6009 |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-12-13T10:27:02Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Endocrine Disorders |
| spelling | doaj.art-9a502c0c4a5247a887d412b2bc0e60092022-12-21T23:51:00ZengBMCBMC Endocrine Disorders1472-68232017-12-0117111110.1186/s12902-017-0227-xSocio-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)Andreas Heltberg0Volkert Siersma1John Sahl Andersen2Christina Ellervik3Henrik Brønnum-Hansen4Jakob Kragstrup5Niels de Fine Olivarius6Section of General Practice, Institute of Public Health, Faculty of Health SciencesThe Research Unit for General Practice, Department of Public Health, University of CopenhagenSection of General Practice, Institute of Public Health, Faculty of Health SciencesDepartment of Production, Research, and InnovationDepartment of Social Medicine, University of CopenhagenSection of General Practice, Institute of Public Health, Faculty of Health SciencesThe Research Unit for General Practice, Department of Public Health, University of CopenhagenAbstract 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).http://link.springer.com/article/10.1186/s12902-017-0227-xType 2 diabetes mellitusSocial inequalitiesInterventionClinical outcomes |
| spellingShingle | Andreas Heltberg Volkert Siersma John Sahl Andersen Christina Ellervik Henrik Brønnum-Hansen Jakob Kragstrup Niels de Fine Olivarius 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) BMC Endocrine Disorders Type 2 diabetes mellitus Social inequalities Intervention Clinical outcomes |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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 |
| topic | Type 2 diabetes mellitus Social inequalities Intervention Clinical outcomes |
| url | http://link.springer.com/article/10.1186/s12902-017-0227-x |
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