Patient Empowerment Programme (PEP) in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus: A Population-based Propensity Matched Cohort Study

Aims: To assess whether a structured diabetes education programme, 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 type 2 diabetes mellitus (T2DM) patients in primary care. Methods and Methods: A Chinese cohort of 27,278 T2DM patients without prior occurrence of CVD events on or before baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. PEP was provided to T2DM patients treated at primary care outpatient clinics through community trained professional educators. Non-PEP participants were matched one-to-one with the PEP participants using propensity score method with respect to their baseline covariates. Cox proportional hazard regressions were performed to estimate the associations of 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 non-PEP participants) patients suffered a first CVD event. After adjusting for confounding variables, PEP participants had a lower incidence of all-cause mortality (hazard ratio: 0.564; 95%CI:0.445-0.715; P<0.001), first CVD (hazard ratio: 0.807; 95%CI:0.696-0.935; P=0.004) and stroke (hazard ratio: 0.702; 95%CI:0.569-0.867; P=0.001) events than those without PEP. Conclusions: Enrolment in PEP was associated with reduced all-cause mortality and first CVD events among T2DM patients. The CVD benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and enhancement of quality of diabetes care in primary care. Word Count: 250