國家衛生研究院 NHRI:Item 3990099045/8481
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    Please use this identifier to cite or link to this item: http://ir.nhri.org.tw/handle/3990099045/8481


    Title: Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan: Accounting for behavioral therapy, nutrition education and therapeutics
    Other Titles: 「台灣糖尿病社區聯合照護網絡暨長期追蹤計畫」中管理指標的發展軌跡：控制行為、營養教育與藥物治療後的結果
    Authors: Chang, HY;Wahlqvist, ML;Liu, WL;Lee, MS;Shin, SJ;Li, YS;Chang, CJ;Chang, CT;Fuh, MT;Yang, HJ;Tai, TY;Hsu, CC
    Contributors: Division of Health Services and Preventive Medicine
    Abstract: BACKGROUND AND AIM: Glycated hemoglobin (HbA1c) 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. HbA1c 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 HbA1c. HbA1c 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 HbA1cs (-0.14%= -1.5 mmol/mol, p=0.026). The intermediate trajectory patients with intensive education had HbA1cs higher than the low trajectory patients with conventional education (beta=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (beta=0.223, p=0.154). CONCLUSIONS: Novel strategies beyond current education and pharmacotherapeutic regimens are needed to lower HbA1c at least 11 mmol/mol for the high HbA1c group to minimize comorbidities.
    Date: 2014-12
    Relation: Asia Pacific Journal of Clinical Nutrition. 2014 Dec;23(4):592-606.
    Link to: http://dx.doi.org/10.6133/apjcn.2014.23.4.06
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0964-7058&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000347143600011
    Cited Times(Scopus): http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84925546651
    Appears in Collections:[Chih-Cheng Hsu] Periodical Articles
    [MARK LAWRENCE WAHLQVIST(2008-2012)] Periodical Articles
    [Hsing-Yi Chang] Periodical Articles

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