Winkley Kirsty, Stahl Daniel, Chamley Mark, Stopford Rosanna, Boughdady Monica, Thomas Stephen, Amiel Stephanie A, Forbes Angus, Ismail Khalida
Dept of Psychological Medicine, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Dept of Biostatistics, King's College London & Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Patient Educ Couns. 2016 Jan;99(1):101-7. doi: 10.1016/j.pec.2015.08.015. Epub 2015 Aug 13.
The aims were to determine the association between individual and neighbourhood factors and attendance at structured education amongst people with newly diagnosed type 2 diabetes (T2DM).
Multi-level analysis of questionnaire data from a prospective cohort of adults newly diagnosed T2DM. Setting was primary care, London, UK. Main outcome was attendance at structured education within 2 years.
Of 1790 people recruited, attendance data were available for 1626 (91%). Only 22.4% (n=365/1626) attended education. Attendance was independently associated with female gender (OR 1.28, 95% CI 1.05-1.46), lower HbA1c (OR 0.98 mmol/mol 95% CI 0.97-0.99) and non-smoker status (OR 1.36, 95% CI 1.07-1.55). General practice covariates, achievement of primary care targets for glycaemic control (OR 1.05, 95% C.I. 1.01-1.08) and recording of retinal screening (OR 0.96, 95% C.I. 0.93-0.99) were independently associated with attendance but unexplained general practice clustering accounted for 17% of the variance.
Education uptake is low amongst people with new onset T2DM. Attenders are more likely to be female, non-smokers with better HbA1c. General practices achieving glycaemic targets are more likely to have patients who attend education.
Strategies are needed to improve attendance at structured diabetes education particularly amongst hard to reach groups.
确定个体因素和社区因素与新诊断的2型糖尿病（T2DM）患者参加结构化教育之间的关联。
对新诊断T2DM的成年前瞻性队列的问卷数据进行多层次分析。研究地点为英国伦敦的初级医疗保健机构。主要结局是在2年内参加结构化教育的情况。
在招募的1790人中，有1626人（91%）可获取出勤数据。只有22.4%（n = 365/1626）的人参加了教育。出勤情况与女性性别（比值比[OR] 1.28，95%置信区间[CI] 1.05 - 1.46）、较低的糖化血红蛋白（HbA1c）水平（OR 0.98 mmol/mol，95% CI 0.97 - 0.99）和非吸烟状态（OR 1.36，95% CI 1.07 - 1.55）独立相关。全科医疗协变量、血糖控制初级保健目标的达成情况（OR 1.05，95% CI 1.01 - 1.08）以及视网膜筛查记录（OR 0.96，95% CI 0.93 - 0.9)与出勤独立相关，但无法解释的全科医疗聚类占变异的17%。
新发病的T2DM患者中教育参与率较低。参加者更可能是女性、非吸烟者且HbA1c水平较好。实现血糖目标的全科医疗更可能有患者参加教育。
需要采取策略来提高结构化糖尿病教育的参与率，特别是在难以接触到的群体中。
