Patient-centred care, health behaviours and cardiovascular risk factor levels in people with recently diagnosed type 2 diabetes: 5-year follow-up of the ADDITION-Plus trial cohort

摘要

Objective 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. Design Population-based prospective cohort study. Setting 34 general practices in East Anglia, UK, delivering organised diabetes care. Participants 478 patients recently diagnosed with type 2 diabetes aged between 40 and 69?years enrolled in the ADDITION-Plus trial. Main outcome measures 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. Results 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)). Conclusions 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. Trial registration number ISRCTN99175498; Post-results.