Dambha-Miller Hajira, Cooper Andrew J M, Simmons Rebecca K, Kinmonth Ann Louise, Griffin Simon J
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
BMJ Open. 2016 Jan 6;6(1):e008931. doi: 10.1136/bmjopen-2015-008931.
To examine the association between the experience of patient-centred care (PCC), health behaviours and cardiovascular disease (CVD) risk factor levels among people with type 2 diabetes.
Population-based prospective cohort study.
34 general practices in East Anglia, UK, delivering organised diabetes care.
478 patients recently diagnosed with type 2 diabetes aged between 40 and 69 years enrolled in the ADDITION-Plus trial.
Self-reported and objectively measured health behaviours (diet, physical activity, smoking status), CVD risk factor levels (blood pressure, lipid levels, glycated haemoglobin, body mass index, waist circumference) and modelled 10-year CVD risk.
Better experiences of PCC early in the course of living with diabetes were not associated with meaningful differences in self-reported physical activity levels including total activity energy expenditure (β-coefficient: 0.080 MET h/day (95% CI 0.017 to 0.143; p=0.01)), moderate-to-vigorous physical activity (β-coefficient: 5.328 min/day (95% CI 0.796 to 9.859; p=0.01)) and reduced sedentary time (β-coefficient: -1.633 min/day (95% CI -2.897 to -0.368; p=0.01)). PCC was not associated with clinically meaningful differences in levels of high-density lipoprotein cholesterol (β-coefficient: 0.002 mmol/L (95% CI 0.001 to 0.004; p=0.03)), systolic blood pressure (β-coefficient: -0.561 mm Hg (95% CI -0.653 to -0.468; p=0.01)) or diastolic blood pressure (β-coefficient: -0.565 mm Hg (95% CI -0.654 to -0.476; p=0.01)). Over an extended follow-up of 5 years, we observed no clear evidence that PCC was associated with self-reported, clinical or biochemical outcomes, except for waist circumference (β-coefficient: 0.085 cm (95% CI 0.015 to 0.155; p=0.02)).
We found little evidence that experience of PCC early in the course of diabetes was associated with clinically important changes in health-related behaviours or CVD risk factors.
ISRCTN99175498; Post-results.
研究2型糖尿病患者以患者为中心的护理（PCC）体验、健康行为与心血管疾病（CVD）危险因素水平之间的关联。
基于人群的前瞻性队列研究。
英国东安格利亚的34家全科诊所，提供有组织的糖尿病护理。
478名年龄在40至69岁之间、最近被诊断为2型糖尿病的患者，纳入ADDITION-Plus试验。
自我报告和客观测量的健康行为（饮食、身体活动、吸烟状况）、CVD危险因素水平（血压、血脂水平、糖化血红蛋白、体重指数、腰围）以及模拟的10年CVD风险。
糖尿病病程早期更好的PCC体验与自我报告的身体活动水平的显著差异无关，包括总活动能量消耗（β系数：0.080代谢当量小时/天（95%可信区间0.017至0.143；p = 0.01））、中度至剧烈身体活动（β系数：5.328分钟/天（95%可信区间0.796至9.859；p = 0.01））以及久坐时间减少（β系数：-1.633分钟/天（95%可信区间-2.897至-0.368；p = 0.01））。PCC与高密度脂蛋白胆固醇水平（β系数：0.002毫摩尔/升（95%可信区间0.001至0.004；p = 0.03））、收缩压（β系数：-0.561毫米汞柱（95%可信区间-0.653至-0.468；p = 0.01））或舒张压（β系数：-0.565毫米汞柱（95%可信区间-0.654至-0.476；p = 分0.01））的临床显著差异无关。在长达5年的延长随访中，我们没有观察到明确证据表明PCC与自我报告、临床或生化结局相关，除了腰围（β系数：0.085厘米（95%可信区间0.015至0.155；p = 0.02））。
我们几乎没有发现证据表明糖尿病病程早期的PCC体验与健康相关行为或CVD危险因素的临床重要变化有关。
ISRCTN99175498；结果公布后。
