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

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 five-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 five 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 five-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 five-years. 628 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 five-years in multivariable models; OR 1.03 (95% CI 1.01 to 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 optimised and how these could be operationalised.