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Patient-level evaluation of community-based, multifactorial intervention to prevent diabetic nephropathy in northern
John-Michael Gamble1, Holly Hoang, Dean T Eurich
1Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
Objective:
To examine whether patients with type 2 diabetes enrolled in community-based clinics uniformly benefit from interventions designed to achieve multiple risk factor targets.
Methods:
Using data from community-based clinics in Alberta, Canada, we examined whether patients achieved targets for blood pressure (<130/80 mm Hg), A1c (≤7%), low-density lipoprotein (LDL) cholesterol (<2.5 mmol/L), weight reduction, exercising, smoking cessation, and meal plan management among 235 patients between 2004 to 2007 with a 1-year follow-up. The effectiveness of the clinics was assessed by the number of targets achieved by individual patients. Patients achieving different degrees of success (0-2, 3-4, and ≥5 targets) were compared.
Results:
Mean age of patients at baseline was 62 years (standard deviation [SD], 12 years), 43% were female, 77% had a history of cardiovascular disease, and mean diabetes duration was 9 years (SD, 9 years). Overall, 47 patients achieved 0 to 2 targets (group 1), 132 achieved 3 to 4 targets (group 2), and 56 achieved ≥5 targets (group 3) out of 7 targets. More patients in group 1 were male and had longer diabetes duration and were more likely to smoke or use insulin. Despite reductions in A1c in all groups and similar use of antihypertensives, there was no improvement in weight or systolic blood pressure (which actually increased) in group 1. Successful patients (group 3) were more likely to report adherence with exercise and a meal plan.
Conclusions:
Despite equally intensive, target-driven pharmacotherapy, this community-based multifactorial intervention was less effective among a subset of patients who did not adhere to lifestyle changes. Strategies to effectively address lifestyle factors will be important as this intervention is refined.
Insights
Community clinics help type 2 diabetes patients manage multiple risk factors. However, adherence to lifestyle changes, like diet and exercise, is crucial for patients to fully benefit from these interventions.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Community-based clinics aim to manage multiple risk factors in type 2 diabetes.
- Intervention effectiveness can vary among patient populations.
Purpose of the Study:
- To assess if type 2 diabetes patients in community clinics uniformly benefit from interventions targeting multiple risk factors.
- To identify factors associated with differential success in achieving risk factor targets.
Main Methods:
- A cohort of 235 patients with type 2 diabetes in Alberta, Canada, was followed for 1 year.
- Interventions focused on blood pressure, A1c, LDL cholesterol, weight, exercise, smoking cessation, and meal plan management.
- Patients were categorized by the number of targets achieved (0-2, 3-4, ≥5).
Main Results:
- Nearly 20% of patients achieved 0-2 targets, 57% achieved 3-4, and 24% achieved ≥5 out of 7 targets.
- Patients achieving fewer targets were more likely male, had longer diabetes duration, and were more prone to smoking or insulin use.
- While A1c improved across groups, weight and systolic blood pressure did not improve in the lowest-achieving group.
Conclusions:
- Intensive pharmacotherapy alone was insufficient for some patients who did not adopt lifestyle changes.
- Adherence to exercise and meal plans was associated with achieving multiple risk factor targets.
- Future interventions require strategies to enhance patient adherence to lifestyle modifications for improved type 2 diabetes management.
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