The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care: A 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP)

Gen Hosp Psychiatry. 2016 Jan-Feb:38:42-52. doi: 10.1016/j.genhosppsych.2015.10.001. Epub 2015 Oct 19.

Abstract

Objective: To assess the effectiveness of an intervention in Type 2 diabetic patients with concurrent psychiatric illness (PI) and compare this with the effectiveness in patients without PI.

Method: In the Diabetes Care in General Practice trial, 1381 patients newly diagnosed with Type 2 diabetes were randomized to 6 years of structured personal diabetes care or routine diabetes care (ClinicalTrials.gov NCT01074762). In this observational post-hoc analysis, the effectiveness of the intervention for diabetes in 179 patients with concurrent PI was analyzed.

Results: During the 19-year follow-up period, patients with PI in the structured personal care group experienced a lower risk for all-cause mortality [105.3 vs. 140.4 events per 1000 patient-years; hazard ratio (HR): 0.63, P=0.023, multivariably adjusted], diabetes-related death (66.0 vs. 95.1; HR: 0.57, P=0.015), any diabetes-related endpoint (169.5 vs. 417.5; HR: 0.47, P=0.0009) and myocardial infarction (54.1 vs. 104.4; HR: 0.48, P=0.013), compared to patients with PI in the routine care group. This translates into a number needed to treat over 10 years of three or lower for these outcomes.

Conclusion: These findings suggest that in primary care, structured diabetes care allowing for individualization was highly effective among diabetic patients with co-occurring PI.

Keywords: All-cause mortality; Primary care; Psychiatric illness; Randomized controlled trial; Type 2 diabetes mellitus.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Comorbidity
  • Denmark
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / mortality*
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy
  • Disease Management
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Mortality*
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / mortality
  • Peripheral Vascular Diseases / epidemiology
  • Peripheral Vascular Diseases / mortality
  • Precision Medicine
  • Primary Health Care / methods*
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Self Care
  • Stroke / epidemiology
  • Stroke / mortality

Associated data

  • ClinicalTrials.gov/NCT01074762