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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 Special Administrative Region

    Asia Diabetes Foundation, Hong Kong Special Administrative Region

    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 Special Administrative Region
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  • Risa Ozaki
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region
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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 Special Administrative Region
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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 Special Administrative Region
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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 Special Administrative Region
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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 Special Administrative Region

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
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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 Special Administrative Region

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
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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 Special Administrative Region (A.P.S. Kong).
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region

    Asia Diabetes Foundation, Hong Kong Special Administrative Region

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
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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 Special Administrative Region (A.P.S. Kong).
    Affiliations
    Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region

    Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
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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 in obese patients with type 2 diabetes (T2D) and poor glycemic control.

      Methods

      Patients with T2D and HbA1c ≥ 8 % and body mass index (BMI) ≥ 27 kg/m2 and/or waist circumference ≥ 80 cm in women and ≥90 cm 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 ± 9.9 cm (men), 95.3 ± 9.8 cm (women)], 104 received MIC and 103 received UC. 95 % patients had repeat assessments 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.

      Keywords

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      References

      1. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1151–210.

        • Kong A.P.
        • Chan N.N.
        • Chan J.C.
        The Role of Adipocytokines and Neurohormonal Dysregulation in Metabolic Syndrome.
        Current Diabetes Rev. 2006; 2: 397-407
        • Edelman S.V.
        • Polonsky W.H.
        Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control.
        Diabetes Care. 2017; 40: 1425-1432
        • Chan J.C.
        • Gagliardino J.J.
        • Baik S.H.
        • Chantelot J.M.
        • Ferreira S.R.
        • Hancu N.
        • et al.
        Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS).
        Diabetes Care. 2009; 32: 227-233
        • Dietz W.H.
        • Baur L.A.
        • Hall K.
        • Puhl R.M.
        • Taveras E.M.
        • Uauy R.
        • et al.
        Management of obesity: improvement of health-care training and systems for prevention and care.
        Lancet. 2015; 385: 2521-2533
        • Wang C.Y.
        • Yu N.C.
        • Sheu W.H.
        • Tsai S.T.
        • Tai T.Y.
        Team care of type 2 diabetes mellitus in Taiwan.
        Diabetes Res Clin Pract. 2014; 106: S309-S313
        • Lim L.L.
        • Lau E.S.H.
        • Kong A.P.S.
        • Davies M.J.
        • Levitt N.S.
        • Eliasson B.
        • et al.
        Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.
        Diabetes Care. 2018; 41: 1312-1320
        • Chan J.C.
        • Sui Y.
        • Oldenburg B.
        • Zhang Y.
        • Chung H.H.
        • Goggins W.
        • et al.
        Effects of telephone-based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial.
        JAMA Intern Med. 2014; 174: 972-981
        • Piwernetz K.
        • Home P.D.
        • Snorgaard O.
        • Antsiferov M.
        • Staehr-Johansen K.
        • Krans M.
        For the DiabCare Monitoring Group of the St. Vincent Declaration Steering Committee. Monitoring the targets of the St. Vincent declaration and the implementation of quality management in diabetes care: the DiabCare initiative.
        Diabet Med. 1993; 10: 371-377
        • Chan J.C.N.
        • Lim L.L.
        • Luk A.O.Y.
        • Ozaki R.
        • Kong A.P.S.
        • Ma R.C.W.
        • et al.
        From Hong Kong Diabetes Register to JADE Program to RAMP-DM for Data-Driven Actions.
        Diabetes Care. 2019; 42: 2022-2031
        • Kong A.P.
        • Yang X.
        • Ko G.T.
        • So W.Y.
        • Chan W.B.
        • Ma R.C.
        • et al.
        Effects of treatment targets on subsequent cardiovascular events in Chinese patients with type 2 diabetes.
        Diabetes Care. 2007; 30: 953-959
        • Toobert D.J.
        • Hampson S.E.
        • Glasgow R.E.
        The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.
        Diabetes Care. 2000; 23: 943-950
        • Shiu A.T.
        • Choi K.C.
        • Wong R.Y.
        The Chinese version of the Diabetes Empowerment Scale-short form.
        Patient Educ Couns. 2012; 87: 258-260
        • Gao F.
        • Ng G.Y.
        • Cheung Y.B.
        • Thumboo J.
        • Pang G.
        • Koo W.H.
        • et al.
        The Singaporean English and Chinese versions of the EQ-5D achieved measurement equivalence in cancer patients.
        J Clin Epidemiol. 2009; 62: 206-213
        • Zhang Y.
        • Ting R.
        • Lam M.
        • Lam J.
        • Nan H.
        • Yeung R.
        • et al.
        Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes.
        J Affect Disord. 2013; 151: 660-666
        • UKPDS
        Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
        Lancet. 1998; 352: 837-853
        • Holman R.R.
        • Paul S.K.
        • Bethel M.A.
        • Matthews D.R.
        • Neil H.A.
        10-year follow-up of intensive glucose control in type 2 diabetes.
        N Engl J Med. 2008; 359: 1577-1589
      2. U K Prospective Diabetes Study Group. UK Prospective Diabetes Study 16. Overview of 6 years' therapy for Type II diabetes: a progressive disease. Diabetes 1995;44:1249–58.

        • Kahn S.E.
        • Haffner S.M.
        • Heise M.A.
        • Herman W.H.
        • Holman R.R.
        • Jones N.P.
        • et al.
        Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy.
        N Engl J Med. 2006; 355 (Epub 006 Dec 4): 2427-2443
        • Kahn S.E.
        • Prigeon R.L.
        • Schwartz R.S.
        • Fujimoto W.Y.
        • Knopp R.H.
        • Brunzell J.D.
        • et al.
        Clinical review 135: The importance of beta-cell failure in the development and progression of type 2 diabetes: Obesity, body fat distribution, insulin sensitivity and Islet beta-cell function as explanations for metabolic diversity.
        J Clin Endocrinol Metab. 2001; 86: 4047-4058
        • Khunti K.
        • Wolden M.L.
        • Thorsted B.L.
        • Andersen M.
        • Davies M.J.
        Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people.
        Diabetes Care. 2013; 36: 3411-3417
        • Romano M.J.
        • Segal J.B.
        • Pollack C.E.
        The Association Between Continuity of Care and the Overuse of Medical Procedures.
        JAMA Intern Med. 2015; 175: 1148-1154
        • Rutten G.
        • van Vugt H.A.
        • de Weerdt I.
        • de Koning E.
        Implementation of a Structured Diabetes Consultation Model to Facilitate a Person-Centered Approach: Results From a Nationwide Dutch Study.
        Diabetes Care. 2018; 41: 688-695
        • Kim J.M.
        • Hong J.W.
        • Noh J.H.
        • Kim D.J.
        Factors Associated with Participation in Diabetes Education: The Korea National Health and Nutrition Examination Survey 2007 to 2009.
        Diabetes Metab J. 2016; 40: 447-453
        • Chatterjee S.
        • Davies M.J.
        • Heller S.
        • Speight J.
        • Snoek F.J.
        • Khunti K.
        Diabetes structured self-management education programmes: a narrative review and current innovations.
        Lancet Diabetes Endocrinol. 2018; 6: 130-142
        • Funnell M.M.
        • Anderson R.M.
        Changing office practice and health care systems to facilitate diabetes self-management.
        Curr Diab Rep. 2003; 3: 127-133
        • Fisher E.B.
        • Coufal M.M.
        • Parada H.
        • Robinette J.B.
        • Tang P.Y.
        • Urlaub D.M.
        • et al.
        Peer support in health care and prevention: cultural, organizational, and dissemination issues.
        Annu Rev Public Health. 2014; 35: 363-383
        • Spencer M.S.
        • Kieffer E.C.
        • Sinco B.
        • Piatt G.
        • Palmisano G.
        • Hawkins J.
        • et al.
        Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults.
        Diabetes Care. 2018; 41: 1414-1422
        • Fonseca V.A.
        Defining and characterizing the progression of type 2 diabetes.
        Diabetes Care. 2009; 32: S151-S156
        • Chan J.C.N.
        • Lim L.L.
        • Wareham N.J.
        • Shaw J.E.
        • Orchard T.J.
        • Zhang P.
        • et al.
        The Lancet Commission on diabetes: using data to transform diabetes care and patient lives.
        Lancet. 2021; 396: 2019-2082
        • Magliano D.J.
        • Chen L.
        • Carstensen B.
        • Gregg E.W.
        • Pavkov M.E.
        • Salim A.
        • et al.
        Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data.
        Lancet Diabetes Endocrinol. 2022; 10: 112-119