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).
Highlights
We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes
The purpose of the trial was to test whether structured personal care, compared to routine care, for patients newly diagnosed with type 2 diabetes mellitus (T2DM), reduced the incidence of seven pre-defined outcomes, including all-cause mortality and any diabetes-related outcome [18, 24]
The results do not confirm results from studies of the general population showing that the number of consultations at the General Practitioner (GP) increases with decreasing socio-economic status [15, 32]
Summary
We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes. Epidemiological studies have repeatedly shown increased occurrence of type 2 diabetes mellitus (T2DM) among people with low socioeconomic status [1, 2] and living in rural areas [3]. Due to improved diabetes care, mortality of T2DM patients has decreased substantially in recent decades [4], this trend has been less favourable among those with low socio-economic status (SES) [5,6,7,8,9,10]. A recent Scandinavian study showed increased mortality among people of low SES, but could not show any systematic differences in mortality between patients living in rural and urban areas [8]. Inequality in access to and utilization of health care [16, 17] could influence the course of T2DM [18, 19]
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