Teaching and motivating patients to control their risk factors retards progression of cardiovascular as well as microvascular sequelae of Type 2 diabetes mellitus- a randomized prospective 8 years follow-up study.
OBJECTIVE
To examine whether motivating patients to gain expertise and closely follow their risk parameters will attenuate the course of microvascular and cardiovascular sequelae of diabetes.


METHODS
A randomized prospective study on 165 patients with diabetes mellitus Type 2, hypertension (> 140/90 mmHg) and hyperlipidaemia (LDL-C > 3 mmol/l), referred for consultation to a diabetes clinic in an academic hospital. Patients were randomly allocated to standard consultation (SC) or to a patient participation (PP) and teaching programme. Follow-up continued by primary care physicians.


RESULTS
The mean follow-up was 7.7 years. SC group patients each attended eight annual consultations. The PP patients initiated on average 1.2 +/- 0.8 additional consultations per annum. The relative risk (RR) over 8 years, for the combined cardiovascular event index in the intervention (PP) vs. the control (SC) group was 0.65 (95% CI 0.41-0.89, P = 0.001). Nephropathy developed in 14 vs. 7 patients in the SC and PP groups, respectively, RR 0.50 (95% CI 0.28-0.85, P = 0.02), retinopathy developed in 35 vs. 21 patients, RR 0.60 (95% CI 0.21-0.82, P = 0.03). Throughout the study, period blood pressure, LDL-C and HbA1c were significantly lower in the PP than in the SC patients.


CONCLUSIONS
Well-informed and motivated patients, were more successful in maintaining good control of their risk factors, resulting in reduced cardiovascular risk and slower progression of microvascular disease.
Rachmani
R
R
Department of Medicine, Sackler School of Medicine, Tel-Aviv University and Meir Hospital, Kfar-Sava, Israel.
Slavachevski
I
I
Berla
M
M
Frommer-Shapira
R
R
Ravid
M
M
D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000517:prevention & control* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000517:prevention & control; D018450:Disease Progression; D004812:Epidemiologic Methods; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D010353:Patient Education as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control