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- Title
Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan: accounting for behavioral therapy, nutrition education and therapeutics.
- Authors
Hsing-Yi Chang; Wahlqvist, Mark L.; Wen-Ling Liu; Meei-Shyuan Lee; Shyi-Jang Shin; Yu-Sheng Li; Chih-Jen Chang; Chwen-Tzuei Chang; Mao-Tsu Fuh; Hung-Jen Yang; Tong-Yuan Tai; Chih-Cheng Hsu
- Abstract
Background and aim: Glycated hemoglobin (HbAlc) assessment is basic to diabetes management. Little is done to describe the whole spectrum of the trajectory, its related temporal patterns of metabolic indices, and comorbidities. Methods and Results: This was a longitudinal study. In the Diabetes Management through Integrated Delivery System project in Taiwan, enrollees had diabetes, but no major comorbidities. They were randomized into intensive or conventional education (health, diet and exercise) groups. HbAlc was classified by a groupbased trajectory model on the basis of repeated six-monthly measurements. We analyzed data from 1091 subjects who had at least two measurements on HbAlc. HbAlc exhibited three distinct ranges of low (42-53 mmol/mol), intermediate (64-75 mmol/mol) and high (97 mmol/mol), all of which persisted for 4.5 years regardless of receiving intensive education or not. Temporal changes and a time-group interaction were found for triglycerides, total cholesterol. HDL-C and LDL-C. The high trajectory was associated with the major co-morbidities of retinopathy, nephropathy, neuropathy, stroke, hypoglycemia, and ketoacidosis. Patients in the intensive education group (62.4%), which were equally distributed in the three trajectories, had significantly lower HbAlcs (-0.14%= -1.5 mmol/mol. p=0.026). The intermediate trajectory patients with intensive education had HbAlcs higher than the low trajectory patients with conventional education (β=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group ((3=0.223, β=0.154). Conclusions: Novel strategies beyond current education and pharmacotherapeutic regimens are needed to lower HbAlc at least 11 mmol/mol for the high HbAlc group to minimize comorbidities.
- Subjects
TYPE 2 diabetes treatment; HEMOGLOBINS; DISEASE management; PREVENTION of diabetes complications; BLOOD sugar monitoring; BEHAVIOR therapy; COMORBIDITY; PATIENT education
- Publication
Asia Pacific Journal of Clinical Nutrition, 2014, Vol 23, Issue 4, p592
- ISSN
0964-7058
- Publication type
Article
- DOI
10.6133/apjcn.2014.23.4.06