Primary care experience and remission of Type 2 diabetes: a population-based prospective cohort study.
Oxford University Press
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Dambha-Miller, H., Day, A., Kinmonth, A. L., & Griffin, S. (2020). Primary care experience and remission of Type 2 diabetes: a population-based prospective cohort study.. Family practice https://doi.org/10.1093/fampra/cmaa086
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.
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.
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10119)
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/08/116/300)
Department of Health (via National Institute for Health Research (NIHR)) (11938/ DRF-2015-08-027)
Wellcome Trust (061895/Z/00/Z)
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External DOI: https://doi.org/10.1093/fampra/cmaa086
This record's URL: https://www.repository.cam.ac.uk/handle/1810/308295
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