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Self-rated health, coping, symptoms and Haemoglobin A1c in patients receiving structured diabetes care in general practice in Denmark

Anni B.S. Nielsen  


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Accepted by: Faculty of Health Science University of Copenhagen
Defended on: March 7, 2005
Official opponents: Lektor, dr.med., ph.d. Kirsten Avlund , professor, dr.med., ph.d., praktiserende læge Jakob Kragstrup , professor, dr.med., praktiserende læge Jóhann Ágúst Sigurðsson, Island
Tutors: Forskningslektor, læge Niels de Fine Olivarius , professor, dr.med., praktiserende læge Hanne Hollnagel

Published in the PhD Database: March 15, 2005


English abstract
This PhD thesis originates from the Research Unit of General Practice in Copenhagen. The PhD thesis is based on three original papers, which present the results of a study that aims to investigate patients¿ handling, and experience of living with type 2 diabetes (T2DM) when treated in a structured personal care programme in general practice.

The PhD study uses data from 1,428 newly diagnosed patients with diabetes participating in an open, cluster-randomised controlled multicentre study. The intervention group received structured personal care including frequent follow-up and monitoring of diabetic complications (ie potential risk factors) and their treatment.

One year after the time of the diabetes diagnosis HbA1c was close to normal among the intervention group patients, but almost 50 % had diabetes-related symptoms. The patients¿ indication of a relatively poor SRH was associated with reports of relatively many symptoms and relatively high HbA1c levels independently of other relevant factors. There was, however, no relation between HbA1c level and the number of symptoms when other factors that could influence this relation had been accounted for.

Intervention group patients experienced an average improvement in SRH during the first year after diagnosis. Only the patients¿ indication of mental/practical illness burden was related to the size of change of SRH irrespective of other relevant factors. The more negative mental/practical illness burden the patients¿ perceived, the less improvement in SRH as compared with patients with no mental/practical illness burden.

After 6 years of intervention, the observed effect on HbA1c was only present among women. Women in the intervention group had more diabetes-related consultations than both women in the comparison group and men in the intervention group, but neither this nor other factors contributed to an explanation of the HbA1c difference found.

The results of this PhD thesis indicate that symptoms, the amount of illness burden as well as SRH provide additional information about the patients¿ situation that is not achieved by clinical and biological markers. It is therefore recommended to take account of these factors in the consultation and in the clinical treatment of diabetes. This thesis indicates that future research should address SRH and the role of gender in intervention studies.



Danish abstract
Ph.d.-afhandlingen udgår fra Forskningsenheden for Almen Praksis i København. Ph.d.-afhandlingen er baseret på tre originalartikler med resultater fra en undersøgelse, der har til formål at undersøge patienters håndtering og oplevelse af at leve med type 2 diabetes (T2DM), når de er i et struktureret, individualiseret behandlingsregime i almen praksis.

Ph.d.-studiet anvender data fra en cluster-randomiseret kontrolleret multicenterundersøgelse med 1428 nyopdagede diabetikere. Interventionen indebar regelmæssig, struktureret patientopfølgning med personlige behandlingsmål for vigtige risikofaktorer for diabetiske følgesygdomme.

Et år efter diagnosen af diabetes interventionspatienternes gennemsnitlige HbA1c næsten normaliseret, men ca. 50 % angav alligevel diabetesrelaterede symptomer. Patienternes angivelse af relativt dårligt SRH var associeret til rapport af relativt mange symptomer og relativt højt HbA1c-niveau uafhængigt af andre relevante faktorer. Der var dog imidlertid ingen relation mellem HbA1c-niveau og antal symptomer, når der blev taget højde for andre faktorer, der kunne influere på denne relation.

Fra diagnosen af diabetes til et år senere sås en gennemsnitlig bedring af SRH. Kun patienternes angivelse af mental/praktisk sygdomsbyrde var relateret til omfanget af ændring i SRH: Jo mere negativ mental/praktisk sygdomsbyrde patienterne angav, desto mindre var forbedringen i SRH sammenlignet med patienter uden nogen sygdomsbyrde.

Efter 6 års intervention var en effekt på HbA1c kun at se blandt kvinder. Kvinderne i interventionsgruppen havde flere diabetes-relaterede konsultationer end både kvinder i kontrolgruppen og mænd i interventionsgruppen, men hverken dette eller andet kunne forklare kønsforskellen i HbA1c.

Resultaterne fra denne ph.d.-afhandling peger på, at symptomer, omfanget af sygdomsbyrde samt SRH giver information om patienternes situation, der ikke fås vha. kliniske og biologiske markører. Disse faktorer bør derfor inddrages i konsultationen og den kliniske behandling af diabetes. Både SRH og kønnets betydning i konsultationen er interessante fremtidige forskningsområder.