Diabetes self-management is an important measure to reduce the adverse impact of the disease and improve the outcome in patients with diabetes. Existing diabetes self-management studies mainly focus on the evaluation of short-term intervention effects, but rarely report the long-term effects.
To evaluate the short- and long-term effects of group-based self-management activities on comprehensive glycemic control in type 2 diabetes patients in the community.
In 2014, 500 adults with type 2 diabetes were recruited from Fangshan District, Beijing, and randomly divided into a control group (n=241) and an intervention group (n=259). Both groups received routine diabetes follow-up services. The intervention group also received a three-month group-based self-management activities. We conducted four surveys at different times (at baseline, and three months, two years and five years post-intervention) to collect patient demographics, disease condition, comprehensive glycemic control indicators〔body mass index (BMI), blood pressure, fasting plasma glucose (FGP), glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) 〕. Generalized estimating equations were used to analyze the main effect of the self-management activities and the interaction effect of the activities with post-intervention time.
After adjusting for potential confounders, the main effects of the self-management activities on BMI, systolic blood pressure, diastolic blood pressure, FPG, HbA1c, HDL-C, TG an LDL-C were not statistically significant (P>0.05). The main effects of time of intervention on various indicators were statistically significant (P<0.05). Specifically, the BMI, systolic blood pressure, diastolic blood pressure, FPG, HbA1c, HDL-C and LDL-C increased, and TG decreased in the patients after intervention. We found the self-management activities and the intervention time had an interaction effect on BMI〔β (95%CI) =-0.33 (-0.62, -0.05) 〕, FPG〔β (95%CI) =-1.03 (-1.71, -0.35) 〕, and TG〔β (95%CI) =-0.54 (-0.93, -0.14) 〕: the BMI of the intervention group was 0.31 kg/m2 lower than that of the control group at baseline, and was 0.64 kg/m2 lower than that of the control group at three months post-intervention; the FPG of the intervention group was 0.19 mmol/L higher than that of the control group at baseline, but was 0.84 mmol/L lower than that of the control group at two years post-intervention; the TG of the intervention group was 0.03 mmol/L higher than that of the control group at baseline, but was 0.51 mmol/L lower than that of the control group at five years post-intervention.
Group-based self-management activities have a short-term effect on controlling BMI, and may have a long-term effect on controlling FPG and TG in patients with type 2 diabetes.
Smart bracelets are increasingly used in chronic disease management, which help improve patient adherence and motivation to exercise interventions, but more evidence for their long-term effectiveness in patients with type 2 diabetes mellitus (T2DM) in the community needs to be explored.
To develop an intervention model for community-dwelling type 2 diabetes patients using smart bracelets, and to assess its long-term effectiveness in these patients.
From July to August 2018, this study selected 11 community health institutions from 11 districts of Guangzhou (one from each district) as study settings. And from each setting, 10-15 T2DM patients were selected (intervention group), and were compared to sex-matched and age-matched (+/- two years) T2DM patients (control group). The intervention was carried out from September 2018 to August 2019 in two groups, both received standardized health management services provided by the family physician team and underwent the exercise prescribed by an exercise prescriber. The intervention group additionally received health monitoring and management via wearing a smart bracelet, and set personalized exercise challenge goals under the guidance of an exercise prescriber. The score of the Chinese version of Summary of Diabetes Self-Care Activities Measure (SDSCA-C), comprehensive assessment indicators, and attainment rates of key glycemic indicators were compared between the two groups before and after the intervention.
Ninety-two patients in the control group and 144 patients in the intervention group completed one-year intervention and follow-up. After the intervention, the subscale scores of dietary management and foot care management and the total score of SDSCA-C increased notably in the intervention group (P<0.05), but changed insignificantly in the control group (P>0.05). Two groups had no statistically significant differences in all comprehensive assessment indicators at baseline (P>0.05). After one year of intervention, besides a decrease was found in total cholesterol, apolipoprotein A1 and apolipoprotein B in both groups, a reduction was found in waist circumference in the intervention group, and in fasting plasma glucose (FPG), triacylglycerol and low-density lipoprotein cholesterol in the control group (P<0.05) .In terms of the attainment rate of key indicators, the HbA1c attainment rate increased in the intervention group after intervention (P<0.05), and the post-intervention rate was higher than that of the control group (P<0.05). The FPG attainment rate was higher after intervention in both groups (P<0.05). But the high-density lipoprotein cholesterol attainment rate was lower after intervention in both groups (P<0.05) .
Using a smart bracelet helps people with T2DM maintain self-management behaviors over time and keep their blood sugar at target levels. As dyslipidemia is an important factor affecting blood glucose control, pharmacological interventions should be initiated as early as possible to regulate lipid metabolism disorders in addition to lifestyle modification.
The number of elderly diabetic patients is increasing rapidly with the aggravation of population aging. The coexistence of multiple conditions and polypharmacy are common in elderly diabetic patients. Strengthening clinically rational drug use can effectively reduce the incidence of adverse drug events and improve outcomes in these patients.
To understand the characteristics and patterns of polypharmacy including hypoglycemic, antihypertensive, lipid-lowering, antiplatelet agents in elderly patients with type 2 diabetes, so as to provide a reference for promoting rational medication use.
This study retrospectively selected 240 elderly inpatients with type 2 diabetes who were hospitalized in Department of Endocrinology, the Second Affiliated Hospital of Xi'an Jiaotong University from April 1, 2020 to March 31, 2022 by cluster sampling method in April 2022. The drugs used during hospitalization and post-discharge medication regimens were investigated. Descriptive analysis was used to analyze the treatment regimens of hypoglycemic, antihypertensive, lipid-regulating and antiplatelet.
On average, the participants had (13.93±3.12) diagnoses at discharge, (16.48±5.41) kinds of medications during hospitalization, and (8.21±2.46) kinds of long-term medications after discharge. The rate of polypharmacy after discharge reached 89.2% (214/240). After discharge, 216 cases (90.0%) received hypoglycemic treatment, among whom 44.9% (97/216) used single drug therapy, and 58.3% (126/216) were treated with insulin. One hundred and eighty-three cases (76.2%) were treated with antihypertensive therapy, including 44.3% (81/183) with single drug therapy and 79.2% (145/183) with calcium channel blockers. One hundred and eighty-seven cases (77.9%) received lipid-regulation therapy, and 83.4% (156/187) of them received atorvastatin. One hundred and seventeen cases (48.7%) used antiplatelet drugs, among whom 77.8% (91/117) used aspirin. Eighty-four cases (35.0%) received hypoglycemic, antihypertensive, lipid-regulating and antiplatelet therapies.
Polypharmacy is common in elderly patients with type 2 diabetes, including hypoglycemic, antihypertensive, lipid-regulating, antiplatelet and other therapies, which indicates that they have received pre-treatment relatively comprehensive condition evaluation by medical workers. Although the rate of comprehensive management is high in this group, there are still some potential risks of adverse drug events due to irrational use of some drugs alone or in combination.
