Effectiveness Of Intensified Diseases Management Program Among Community Type 2 Diabetic Mellitus Patients

Objective To evaluate the management effect of a clinic-based intensified diseases management(C-IDM)program among type 2 diabetic patients and then provide a scalable management model for other areas.Methods This was a cluster randomized controlled intervention study starting at October 2015.1152 participants were the type 2 diabetic patients from six community health centers(CHC)in Nanjing Chemical Industry Park.The T2 DM patients were randomly allocated a control group receiving Basic Public Health Service Program(BPHSP)and an intervention group receiving both C-IDM and BPHSP.C-IDM mainly consisted of four components(clinical screening targets,referral channel,expert visit,self-management of patients)and a management system integrating the Disease Control and Prevention(CDC),endocrinology department of the general hospital and CHC.The primary and secondary outcome measures were the changes in Hb A1 c,total score of Chinese version Scale of the Diabetes Self-care Activities(SDSCA-C)and BMI,scores of SDSCA-C in diet,exercise,blood glucose monitoring,foot care,separately.The Mixed-effects models were used to evaluate between-group differences in changes of all outcome variables measured both continuously and categorically(the proportions of achieving goals)after adjusting individual and cluster-level confounders.Results1.After the two-year follow-up,data were available for 1104 subjects.There were 522 males(47.3%)and 582 females(52.7%),with an average age of 66.4±9.06 years at baseline.2.The experiment group’s decreased Hb A1 c were higher than that of control group(mean difference(MD)=-0.57,95%CI=-0.79,-0.36).The experiment group’s rate reaching the standard were higher than that of control group(adjusted OR=1.94,95%CI=1.35,2.81)for the people whose value of Hb A1 c was non-reaching standard at baseline.3.The experiment group’s increased total scores of SDSCA-C were higher than that of control group(MD=2.58,95%CI=1.89,3.27).The experiment group’s rate reaching the standard were higher than that of control group(adjusted OR=2.76,95%CI=2.03,3.77)for the people whose total scores of SDSCA-C was nonreaching standard at baseline.4.The experiment group’s decreased BMI were higher than that of control group(MD=-0.29,95%CI=-0.49,-0.10).The experiment group’s rate reaching the standard were higher than that of control group(adjusted OR=1.79,95%CI=1.13,2.85)for the people whose value of BMI was non-reaching standard at baseline.5.The experiment group’s increased blood glucose monitoring scores of SDSCA-C were higher than that of control group(MD=0.22,95%CI=0.03,0.41)Similar results were also observed in increased scores of foot care(MD=1.27,95%CI=0.91,1.64),exercises(MD=0.63,95%CI=0.32,0.94)and diet(MD=0.40,95%CI=0.22,0.57).The experiment group’s rate reaching the standard were higher than that of control group(adjusted OR=2.31,95%CI=1.18,4.50)for the people whose blood glucose monitoring scores of SDSCA-C was non-reaching standard at baseline.Similar results were also observed in foot care(adjusted OR=2.48,95%CI=1.82,3.37)and exercises(adjusted OR=2.09,95%CI=1.34,3.25)but beside in diet.Conclusion This C-IDM program intervention was more effective in controlling glycemic,body weight and improving the self-management ability of type 2 diabetes patients compare to the BPHSP.Experiences from this study are the lessons for Nanjing health practitioners to manage type 2 diabetes patients.