Macrovascular and Microvascular Disease in Obese Patients with Type 2 Diabetes Attending Patient Empowerment Programme

Abstract

Aims: To assess whether Patient Empowerment Programme (PEP) in primary care reduced all-cause mortality, first macrovascular and microvascular disease events in obese type 2 diabetic patients. Methods: A cohort of 6,396 obese type 2 diabetic patients without prior occurrence of macrovascular or microvascular disease events on or before baseline study recruitment date was linked to the administrative database from 2008 to 2013. The PEP was provided to obese type 2 diabetic patients treated at primary care outpatient clinics through community-based professional educators. Non-PEP participants were matched one-to-one with the PEP participants using propensity score method with respect to their baseline covariates. Cox proportional hazard regressions were performed to estimate the associations of the PEP intervention with the occurrence of first macrovascular or microvascular disease events and death from any cause, controlling for demographic and clinical characteristics. Results: During a median 31.5 months of follow-up, 401 (PEP/non-PEP: 172/229) patients suffered from a first macrovascular or microvascular disease event while 93 patients (PEP/non-PEP: 34/59) died from any cause. After adjusting for confounding variables, PEP participants had lower incidence rates of all-cause mortality (hazard ratio (HR): 0.580, 95% confidence interval (CI) 0.374-0.901, P=0.015) and first macrovascular or microvascular disease events (HR: 0.754, 95% CI 0.616-0.921, P=0.006) than those with PEP. Conclusions: Enrolment to PEP was an effective approach in reducing all-cause mortality and first macrovascular or microvascular disease events in obese patients with type 2 diabetes.