Personalised care for patients with type 2 diabetes reduces complications, study findsBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2393 (Published 15 April 2013) Cite this as: BMJ 2013;346:f2393
People with type 2 diabetes who work with their doctors to set individual goals for their treatment have a reduced risk of developing complications, according to a study that followed patients for 19 years.
Researchers from Denmark followed up patients who had taken part in the Diabetes Care In General Practice study—a randomised controlled trial that assessed the effect of six years of structured personal care compared with routine care.1 This study involved 474 general practitioners (GPs) who recruited 1381 patients diagnosed with type 2 diabetes between March 1989 and February 1991.
Patients receiving structured personal care met their general practitioner every three months to set individual treatment goals and decide on which f treatments would suit them best. These goals could include improving blood sugar control, losing weight, and reducing blood pressure. GPs were trained in the importance of diet and were encouraged to delay starting drug therapy, if possible, until at least three months after diagnosis to observe the effect of weight loss. In the other study group, GPs were free to choose any treatment and change it over time.
The study found that structured, individualised personal care reduced fasting plasma glucose (7.9 v 8.7 mmol/L, P<0.001), glycated haemoglobin (8.5% v 9.0%, P<0.001; reference range 5.4-7.4%), systolic blood pressure (145 v 150 mm Hg, P<0.001), and cholesterol (6.0 v 6.1 mmol/L, P=0.029), compared with routine care.
Researchers tracked the patients 14 years after the intervention ended to measure the long term effect of the early treatment.2 During this time, the two groups received similar drug treatment. Researchers found that the group differences in risk factors from six year follow-up had levelled out. In the 19 years, all cause mortality did not differ between the two treatment groups, but patients who received personalised care had a reduced risk of fatal and non-fatal myocardial infarction (27.3 v 33.5, hazard ratio 0.81 (95% confidence 0.68 to 0.98; P=0.030) and any diabetes related endpoint (69.5 v 82.1, hazard ratio 0.83 (0.72 to 0.97), P=0.016).
Lars Hansen, the leading author of the study, said: “It is irrational to treat everybody the same way. We have to put in more effort for some patients than for others, and [GPs] have to set personal goals in cooperation with the patients concerning risk factors such as blood sugar, blood pressure, cholesterol level, and weight.”
Cite this as: BMJ 2013;346:f2393