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Team-based multicomponent care improved and sustained glycaemic control in obese people with type 2 diabetes (T2D) in a Diabetes Centre setting: a quality improvement program with quasi-experimental design

  • Lee-Ling Lim
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China

    Asia Diabetes Foundation, Hong Kong SAR, China

    Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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  • Eric S.H. Lau
    Affiliations
    Asia Diabetes Foundation, Hong Kong SAR, China
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  • Risa Ozaki
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
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  • Tammy T.Y. So
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
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  • Rebecca Y.M. Wong
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
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  • Elaine Y.K. Chow
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
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  • Ronald C.W. Ma
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong SAR, China
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  • Andrea O.Y. Luk
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong SAR, China
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  • Juliana C.N. Chan
    Correspondence
    Corresponding authors at: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China (Alice P.S. Kong).
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China

    Asia Diabetes Foundation, Hong Kong SAR, China

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong SAR, China
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  • Alice P.S. Kong
    Correspondence
    Corresponding authors at: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China (Alice P.S. Kong).
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong SAR, China
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Published:October 31, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110138

      Abstract

      Objective

      To evaluate the effect of a team-based multi-component intervention care (MIC) program on obese T2D with poor glycemic control.

      Methods

      T2D with HbA1c≥8% and body mass index (BMI)≥27 kg/m2 and/or waist circumference≥80cm in women and ≥90cm in men were recruited. The intervention in Diabetes Centre included 1) nurse-led, group-based workshops; 2) review by endocrinologists; 3) telephone reminders by healthcare assistants and 4) peer support during visits. The usual care (UC) group received consultations at outpatient clinic without workshops or peer support. The MIC group received UC after 1-year of intervention. The primary outcome was change of HbA1c from baseline at 1- and 3-year.

      Results

      Of 207 eligible patients [age (mean±standard deviation): 56.9±8.8 years, 47.4% men, disease duration: 13.5±8.2 years, HbA1c: 9.6±1.3%, BMI: 28.8±4.3 kg/m2, waist circumference: 101.5±9.9cm (men), 95.3±9.8cm (women)], 104 received MIC and 103 received UC. 95% patients had repeat assessment at 1- and 3-year. After adjustment for confounders, MIC had greater HbA1c reduction (β -0.51, 95% confidence interval [CI] -1.00 to -0.01; P=0.045) than UC at 1-year, with sustained improvement at 3-year (β -0.56, CI -1.10 to -0.02; P=0.044).

      Conclusion

      Team-based MIC for 1 year improved glycemic control in obese T2D which was sustained at 3-year.
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