Weaver R G, Hemmelgarn B R, Rabi D M, Sargious P M, Edwards A L, Manns B J, Tonelli M, James M T
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Diabet Med. 2014 Dec;31(12):1610-4. doi: 10.1111/dme.12513. Epub 2014 Jun 26.
To determine the association between participation in a brief introductory didactic diabetes education programme and change in HbA1c among individuals with newly diagnosed diabetes.
We identified a population-based cohort of adults newly diagnosed with diabetes between October 2005 and June 2008 in Calgary, Canada, and conducted a retrospective cohort study by linking administrative and laboratory data with programme attendance data. We matched individuals who attended the programme within the first 6 months after diagnosis with those who did not attend, based on their propensity scores. We measured the change in HbA1c between time of diagnosis and 6-18 months later to determine the association between programme participation and change in HbA1c .
HbA1c was measured at baseline and follow-up for 7793 individuals, including 803 programme participants. After propensity score matching, programme participation was associated with a significantly greater adjusted mean reduction in HbA1c between baseline and follow-up of 3.3 mmol/mol (95% CI 2.2-4.3) or 0.30% (95% CI 0.20-0.39). There was a significant interaction between baseline HbA1c and programme participation-the difference in adjusted mean reduction in HbA1c associated with programme participation ranged from 2.7 mmol/mol (0.25%) at baseline HbA1c of 53 mmol/mol (7%) to 6.2 mmol/mol (0.56%) at baseline HbA1c of 97 mmol/mol (11%).
Despite its brevity, participation in a diabetes education programme was associated with an additional reduction in HbA1c in newly diagnosed people that was comparable with that reported in trials of programmes targeted at those with prevalent diabetes.
确定参加简短的糖尿病教育入门课程与新诊断糖尿病患者糖化血红蛋白(HbA1c)变化之间的关联。
我们确定了2005年10月至2008年6月在加拿大卡尔加里新诊断为糖尿病的成年人群队列,并通过将行政和实验室数据与课程出勤数据相链接进行回顾性队列研究。我们根据倾向得分,将诊断后前6个月内参加课程的人与未参加课程的人进行匹配。我们测量了诊断时与6 - 18个月后的HbA1c变化,以确定课程参与与HbA1c变化之间的关联。
对7793名个体进行了基线和随访时的HbA1c测量,其中包括803名课程参与者。经过倾向得分匹配后,课程参与与基线至随访期间HbA1c调整后的平均显著降低相关,降低了3.3 mmol/mol(95%CI 2.2 - 4.3)或0.30%(95%CI 0.20 - 0.39)。基线HbA1c与课程参与之间存在显著交互作用——与课程参与相关的HbA1c调整后平均降低差异范围为:基线HbA1c为53 mmol/mol(7%)时为2.7 mmol/mol(0.25%),基线HbA1c为97 mmol/mol(11%)时为6.2 mmol/mol(0.56%)。
尽管该糖尿病教育课程简短,但新诊断患者参加该课程与HbA1c的额外降低相关,这与针对糖尿病患者的项目试验中报告的情况相当。