title: Patient Empowerment Programme in primary care reduced all-cause mortality and cardiovascular diseases in patients with type 2 diabetes mellitus: a population-based propensity-matched cohort study.
abstract: OBJECTIVE
  To assess whether a structured diabetes education programme, the Patient Empowerment Programme (PEP), was associated with a lower risk of first cardiovascular disease (CVD) event and all-cause mortality in a population-based cohort of patients with type 2 diabetes mellitus (T2DM) in primary care.
  
  
  METHODS
  A Chinese cohort of 27 278 patients with T2DM and without previous CVD events on or before the baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. The PEP was provided to patients with T2DM treated at primary care outpatient clinics through community trained professional educators. PEP non-participants were matched one-to-one with the PEP participants using a propensity score method with respect to their baseline covariates. Cox proportional hazard regression was performed to estimate the associations of the PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure and death from any cause, controlling for baseline characteristics.
  
  
  RESULTS
  During a median of 21.5 months follow-up, 795 (352 PEP participants and 443 PEP non-participants) patients experienced a first CVD event. After adjusting for confounding variables, PEP participants had a lower rate of all-cause mortality [hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.445-0.715; p < 0.001], first CVD (HR 0.807, 95% CI 0.696-0.935; p = 0.004) and stroke (HR 0.702; 95% CI 0.569-0.867; p = 0.001) than those without PEP.
  
  
  CONCLUSIONS
  Enrolment in the PEP was associated with lower all-cause mortality and a lower number of first CVD events among patients with T2DM. The CVD benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and the enhancement of quality of diabetes care in primary care.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Island, Hong Kong.
authors.forename: C K H
authors.initials: CK
authors.lastname: Wong
authors.forename: W C W
authors.initials: WC
authors.lastname: Wong
authors.forename: Y F
authors.initials: YF
authors.lastname: Wan
authors.forename: A K C
authors.initials: AK
authors.lastname: Chan
authors.forename: K L
authors.initials: KL
authors.lastname: Chung
authors.forename: F W K
authors.initials: FW
authors.lastname: Chan
authors.forename: C L K
authors.initials: CL
authors.lastname: Lam
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010349:Patient Compliance; D010353:Patient Education as Topic; D010358:Patient Participation; D011320:Primary Health Care; D015397:Program Evaluation; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D012648:Self Care
keywords: cardiovascular disease; primary care; self-management; structured education; type 2 diabetes