Effectiveness of Self-care Enablement Programmes Delivered in Small Groups or by Telephone to Prevent Complications of Diabetes Mellitus

Abstract

Context: Self-care is an essential part of the management of diabetes mellitus (DM). Studies have demonstrated the benefit of structured DM self-care enablement programs in trial settings but their effectiveness in real-world practice is not clear. Objectives: To evaluate and compare the effectiveness of two DM self-care enablement programmes delivered in small groups (PEP) or by telephone (Call Centre) in real-world primary care. Design: Retrospective cohort study. Setting: Public primary care in Hong Kong. Patients: 63,846 Chinese primary care patients with type 2 DM and without any known complication managed in public primary care clinics in 2012-2013. Usual care only group: 47,802; usual care and PEP: 10,030; usual care and Call Centre: 6,014. Primary and Secondary Outcome Measures: Incidence of CVD was primary; incidence of end stage renal disease (ESRD) and all-cause mortality were secondary. Results: After a median 3-year follow-up, the unadjusted absolute risk reduction (ARR) in CVD, ESRD and all-cause mortality by PEP was -1.34%, -0.26% and -1.66%, respectively. The ARR in CVD, ESRD and all-cause mortality by Call Centre was -0.56%, -0.02% and -0.48%, respectively. Multivariable Cox proportional regressions showed that PEP and Call Centre were associated with significant relative risk reduction (RRR) of CVD compared with usual care group by 14% (Hazard ratio (HR): 0.86; P < 0.001) and 16% (HR: 0.84; P < 0.001), respectively, after adjustment of baseline characteristics. PEP was associated with a significant RRR of 33% (HR: 0.67; P < 0.001) of all-cause mortality compared with Call Centre, but no significant difference was found in the risk of CVD and ESRD between PEP and Call Centre groups. Conclusions: DM self-care enablement programmes delivered in small groups or by telephone in real-world primary care were effective in reducing the risk of CVD, ESRD and all-cause mortality for DM patients.