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Macrovascular and microvascular disease in obese patients with type 2 diabetes attending structured diabetes education program: a population-based propensity-matched cohort analysis of Patient Empowerment Programme (PEP)

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Abstract

Patient Empowerment Programme (PEP) in primary care was effective in preventing diabetes-related complications in patients with diabetes. Nevertheless, the effect of PEP on glycaemic control, weight control, and complications was unclear in obese type 2 diabetic patients. We aimed to assess whether PEP reduced all-cause mortality, first macrovascular and microvascular disease events. A cohort of 6372 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. 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. During a median 31.5 months of follow-up, 350 (PEP/non-PEP: 151/199) patients suffered from a first macrovascular or microvascular disease event while 95 patients (PEP/non-PEP: 34/61) died from any cause. After adjusting for confounding variables, PEP participants had lower incidence rates of all-cause mortality [hazard ratio (HR): 0.589, 95 % confidence interval (CI) 0.380–0.915, P = 0.018] and first macrovascular or microvascular disease events (HR: 0.782, 95 % CI 0.632–0.968, P = 0.024) than those with PEP. 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.

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Acknowledgments

We would like to thank the program teams at the Hospital Authority head office (including Ms. Margaret Tay, Dr. Alexander Chiu, Dr. K.L. Chung, Dr. Alan Y.L. Kwok, Ms. Michelle Wong, and Mr. Gary Ching), and all cluster representatives and clinical staff in the Patient Empowerment Programme for working with our team in this evaluation. Furthermore, we would like to thank Dr. S.V. Lo and the staff of the Statistics & Workforce Planning Department (including Mrs. Edwina Shung, Mr. Peggo Lam, Dr. Kelvin Tsoi, Mr. Adam Ng, Mr. C.F. Yiu and their team-mates) in the Hospital Authority Strategy and Planning Division for their help in coordinating the development of the evaluation frameworks and site visits and facilitating the data collection.

Author contributions

C.K.H.W. wrote the manuscript and researched data. F.W.K.C. and A.C. contributed to acquisition of data and reviewed/edited the manuscript. W.C.W.W. and C.L.K.L. contributed to study design. Y.F.W. and A.K.C.C reviewed/edited the manuscript, contributed to statistical analysis and interpretation of results. W.C.W.W. and C.L.K.L. reviewed/edited the manuscript.

Financial disclosure

This study has been funded by the Hong Kong Hospital Authority (Ref. No: 8011014157) and the Health and Health Services Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhanced Primary Care Study (Ref. No EPC-HKU-2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong

    Carlos K. H. Wong, William C. W. Wong, Eric Y. F. Wan, Anca K. C. Chan & Cindy L. K. Lam

  2. Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong

    Frank W. K. Chan

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  1. Carlos K. H. Wong
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Correspondence to Carlos K. H. Wong.

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NCT01935349, ClinicalTrials.gov.

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Wong, C.K.H., Wong, W.C.W., Wan, E.Y.F. et al. Macrovascular and microvascular disease in obese patients with type 2 diabetes attending structured diabetes education program: a population-based propensity-matched cohort analysis of Patient Empowerment Programme (PEP). Endocrine 53, 412–422 (2016). https://doi.org/10.1007/s12020-015-0843-z

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