Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Island, Hong Kong.
Diabetes Obes Metab. 2015 Feb;17(2):128-35. doi: 10.1111/dom.12397. Epub 2014 Oct 20.
To assess whether a structured diabetes education programme, the Patient Empowerment Programme (PEP), was associated with a lower risk of first cardiovascular disease (CVD) event and all-cause mortality in a population-based cohort of patients with type 2 diabetes mellitus (T2DM) in primary care.
A Chinese cohort of 27 278 patients with T2DM and without previous CVD events on or before the baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. The PEP was provided to patients with T2DM treated at primary care outpatient clinics through community trained professional educators. PEP non-participants were matched one-to-one with the PEP participants using a propensity score method with respect to their baseline covariates. Cox proportional hazard regression was performed to estimate the associations of the PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure and death from any cause, controlling for baseline characteristics.
During a median of 21.5 months follow-up, 795 (352 PEP participants and 443 PEP non-participants) patients experienced a first CVD event. After adjusting for confounding variables, PEP participants had a lower rate of all-cause mortality [hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.445-0.715; p < 0.001], first CVD (HR 0.807, 95% CI 0.696-0.935; p = 0.004) and stroke (HR 0.702; 95% CI 0.569-0.867; p = 0.001) than those without PEP.
Enrolment in the PEP was associated with lower all-cause mortality and a lower number of first CVD events among patients with T2DM. The CVD benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and the enhancement of quality of diabetes care in primary care.
评估结构化糖尿病教育计划（患者赋权计划，PEP）是否与初级保健中 2 型糖尿病（T2DM）患者人群中首次心血管疾病（CVD）事件和全因死亡率的风险降低相关。
将 2008 年至 2013 年期间参加过基层医疗门诊 T2DM 治疗且基线研究招募日期之前无既往 CVD 事件的 27278 名中国队列患者与香港行政数据库进行了关联。通过社区培训的专业教育者向 T2DM 患者提供 PEP。使用倾向评分方法，根据基线协变量，将 PEP 非参与者与 PEP 参与者一对一匹配。使用 Cox 比例风险回归来估计 PEP 与首次 CVD 事件、冠心病、中风、心力衰竭和任何原因导致的死亡的发生之间的关联，同时控制基线特征。
在中位 21.5 个月的随访期间，795 名（352 名 PEP 参与者和 443 名 PEP 非参与者）患者经历了首次 CVD 事件。调整混杂变量后，PEP 参与者的全因死亡率较低[风险比（HR）0.564，95%置信区间（CI）0.445-0.715；p<0.001]，首次 CVD（HR 0.807，95% CI 0.696-0.935；p=0.004）和中风（HR 0.702；95% CI 0.569-0.867；p=0.001）的发生率也低于未参加 PEP 的患者。
参加 PEP 与 T2DM 患者的全因死亡率降低和首次 CVD 事件数量减少相关。PEP 的 CVD 获益可能归因于通过赋权自我护理改善代谢控制，以及增强初级保健中的糖尿病护理质量。
