Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA(1c): Research Design And Methods

This is a cross-sectional subgroup study focusing on sex, performed 6 years after diabetes was diagnosed in patients participating in the DCGP, a pragmatic, open, controlled trial with randomization of practices to structured personal care or routine care.

In 1988, 484 volunteer general practitioners were randomly assigned to an intervention group and a comparison group (Fig. 1). Randomization produced two comparable patient groups.

Of 1,263 patients, 874 completed the final 6-year examination and were included in this substudy (Fig. 1). At least 97.5% of the diabetic patients included were considered to have type 2 diabetes. A similar proportion of patients in each group (190 vs. 199, P = 0.21) had no follow-up.

The intervention

The intervention general practitioners were instructed to give structured personal care, which included quarterly consultations and individualized goal setting for important risk factors. These general practitioners were supported by prompting, short clinical guidelines, feedback on individual patients, and a brief training program. The routine care doctors were free to decide and change treatment.

Ethical considerations

All participants gave informed consent. The protocol was in agreement with the Helsinki Declaration and was approved by the ethics committees of Copenhagen and Frederiksberg.

Questionnaires

The final 6-year examination included doctor questionnaires, information on hospital admissions for relevant conditions, blood and urine samples, weight measurement, and a patient questionnaire (22). The patient questionnaire was based on a literature review and interviews with type 2 diabetic patients. Experienced general practitioners and sociologists reviewed the questionnaire before pilot testing. It contained questions on knowledge about own blood glucose, attitudes toward treatment and diabetes, lifestyle, and social support. Knowledge was measured by two questions concerning the patients’ knowledge of their own blood glucose level and knowledge of the general practitioner’s view of their blood glucose level. Behavioral and attitudinal variables were gathered from questions concerning lifestyle (leisure time physical activity, dietary habits, and the patients’ indication of change in lifestyle after diagnosis) and attitudes (the patients’ feelings about the illness and whether they had worked intentionally with their illness). Furthermore, the patients reported whether they got the necessary support and understanding from family and significant others (social support).

The general practitioners reported the patients’ antidiabetic treatment and the number of diabetes-related consultations within the last year. Practicing ophthalmologists reported the results of funduscopy.

Fig. 1