初级保健经验与 2 型糖尿病缓解：基于人群的前瞻性队列研究。
Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study.
机构信息
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
出版信息
Fam Pract. 2021 Mar 29;38(2):141-146. doi: 10.1093/fampra/cmaa086.
BACKGROUND
Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed.
OBJECTIVE
To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up.
METHODS
A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes.
RESULTS
Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01).
CONCLUSION
Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
背景
通过饮食改变和减肥，可以实现 2 型糖尿病的缓解。在英国，生活方式建议和减肥计划的转介主要发生在初级保健机构，大多数 2 型糖尿病都在那里得到管理。
目的
定量评估初级保健经验与 2 型糖尿病缓解之间在 5 年随访期内的关联。
方法
这是一项针对英国东英格兰 49 家普通实践中登记的 2 型糖尿病成年人的前瞻性队列研究。参与者随访 5 年，并在确诊后第一年完成糖尿病特定初级保健体验的咨询和关系同理心量表（CARE）。5 年随访时通过 HbA1c 水平测量缓解情况。采用单变量和多变量逻辑回归模型来量化初级保健经验与糖尿病缓解之间的关联。
结果
在 867 名参与者中，30%（257 名）在 5 年内实现了 2 型糖尿病的缓解。628 名参与者在随访时有完整数据，被纳入分析。在诊断后 12 个月内报告 CARE 评分较高的参与者在多变量模型中更有可能在 5 年内实现缓解；优势比=1.03（95%置信区间=1.01-1.05，P=0.01）。
结论
初级保健医生在管理疾病的同时，应更加关注提供最佳患者体验，因为这可能有助于 2 型糖尿病的缓解。需要进一步研究哪些初级保健体验方面可以得到优化，以及如何实现这些优化。
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