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Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study.

Accepted version
Peer-reviewed

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Type

Article

Change log

Authors

Dambha-Miller, Hajira 
Day, Alexander 
Kinmonth, Ann Louise 
Griffin, Simon J 

Abstract

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.

Description

Keywords

Doctor–patient relationship, Type 2 diabetes, epidemiology, patient experience, primary care, remission, Adult, Cohort Studies, Diabetes Mellitus, Type 2, Humans, Primary Health Care, Prospective Studies, Weight Loss

Journal Title

Fam Pract

Conference Name

Journal ISSN

0263-2136
1460-2229

Volume Title

38

Publisher

Oxford University Press (OUP)

Rights

All rights reserved
Sponsorship
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10119)
Medical Research Council (G0001164)
NETSCC (None)
Medical Research Council (MC_UU_12015/4)
Department of Health (via National Institute for Health Research (NIHR)) (11938/ DRF-2015-08-027)
Wellcome Trust (061895/Z/00/Z)
ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no: G061895), the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme: MC_UU_12015/4), the NIHR Health Technology Assessment Programme (grant reference no: 08/116/300), NIHR Programme Grants for Applied Research (RP-PG-0606-1259) National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and the NIHR. SJG is an NIHR Senior Investigators. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. Bio-Rad provided equipment for HbA1c testing during the screening phase. Bio-Rad provided equipment for HbA1c testing during the screening phase. The Primary Care Unit is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. SJG is an NIHR Senior Investigator. HDM was an NIHR Doctoral Research Fellow (DRF-2015-08-027). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.