Intervention Of Shared Medical Appointments For The Comprehensive Goal In Type 2 Diabetes Mellitus

Objectives:To investigate the effects of shared medical appointments(SMA)on the clinical indicators and management ability of patients with type 2 diabetes mellitus(T2DM).Methods:T2DM patients who were treated in the Nanjing University of Chinese Medicine Affiliated Hospital,Endocrinology Department from April 2019 to August 2020 were divided into SMA model group and routine outpatient model group.The SMA group were invited to participate in the SMA monthly.The control group weren’t participated in any management but ordinary outpatient.The height(Ht),weight(Wt),waist circumference(Wc),systolic blood pressure(SBP),and diastolic blood pressure(SBP)were measured,and body mass index(BMI)was calculated.Professional instrument detected fasting blood glucose(FBG),2 hours postprandial blood glucose(2hPBG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS),and the homeostasis model assessment-insulin resistance(HOMA-IR)was evaluated as well.The total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)as well as liver and kidney function indicators were also detected.All patients were asked to fill in the questionnaires including diabetes specific quality of life scale(DSQLS),the summary of diabetes self care action(SDSCA)and the diabetes management self-efficacy scale(DMSES)quarterly.All these indicators were compared between and in the groups.Results:Total 52 patients completed the study(the SMA group enrolled 27 cases,the control group enrolled 25 cases).There were no significant differences of the baseline data between the two groups before intervention(P>0.05).After 3 months,the levels of SBP,FBG,2hPBG and HOMA-IR of the SMA group were significantly lower than those of the control group[127.85±15.32 vs.137.08±13.00,P=0.024;6.74±1.18 vs.7.11±1.42,P=0.007;10.53±3.10 vs.12.90±3.83,P=0.017;2.17(1.23,3.84)vs.3.13(2.20,10.33),P=0.014].The rate of patients with HbA1c<6.5%in the SMA group was significantly higher than that in the control group[14(51.9%)vs.6(24.0%),P=0.039].There were no significant differences in BMI,Wc,DBP,HbA1c,blood lipid levels as well as liver and kidney function between two groups(P>0.05).The quality of life,self-management ability and self-management efficiency of the SMA group were significantly better than those of the control group(43.96±7.32 vs.56.40±5.02,P<0.001;68.04±12.24 vs.55.52±7.06,P<0.001;156.48±31.32 vs.123.20±11.32,P<0.001).The level of HbA1c decreased significantly after 3months among the patients with the level of HbA1c<7.0%(n=13)before the treatment(5.89±0.38 vs.6.22±0.37,P=0.038),the total exercise time every week and the quality of life were significantly improved(494.23 ±276.84 vs.293.08±201.14,P=0.045;45.31±7.40 vs.52.69±7.94,P=0.022)among the 13 patients.No significant difference was observed of the level of FBG,2hPBG,self-management ability or self-management efficiency(P>0.05).Among the patients with the level of HbA1c≥7.0%(n=14)before the treatment,there were no significant differences in the levels of FBG,2hPBG,HbA1c,total exercise time every week and self-management ability after 3 months(P>0.05).However,the quality of life and self-management efficiency were significantly improved in these 14 patients(42.79±7.83 vs.59.21±23.17,P=0.018:154.36±29.54 vs.116.64±42.78,P=0.012).Among the 27 patients in the SMA group,4(14.8%),11(40.8%)and 12(44.4%)patients participated in 1,2 and 3 visits respectively.There were no significant differences in blood glucose and exercise time every week in patients who participated in 1 or 2 visits(P>0.05).The quality of life and self-management ability were improved,though there was no statistical significance in patients who participated in 1 or 2 visits(P>0.05).In patients who participated in 3 visits,there were no significant differences in the levels of FBG,2hPBG,HbA1c and the total exercise time every week(P>0.05),while the quality of life and self-management ability were significantly enhanced(45.08±8.73 vs.56.42±7.57,P=0.003;161.50±30.65 vs.113.83±35.85,P=0.002).Conclusions:The model of SMA combined the group-based education and multidisciplinary cooperation.SMA increased the rate of blood glucose compliance and decreased the blood glucose as well as HOMA-IR significantly.SMA also improved the self-management efficiency,self-management ability and the quality of life in T2DM patients significantly.