Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan: Accounting for behavioral therapy, nutrition education and therapeutics

Hsing Yi Chang, Mark L. Wahlqvist, Wen Ling Liu, Meei-Shyuan Lee, Shyi Jang Shin, Yu Sheng Li, Chih Jen Chang, Chwen Tzuei Chang, Mao Tsu Fuh, Hung Jen Yang, Tong Yuan Tai, Chih Cheng Hsu

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)

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 (=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (=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.
Original languageEnglish
Pages (from-to)592-606
Number of pages15
JournalAsia Pacific journal of clinical nutrition
Volume23
Issue number4
DOIs
Publication statusPublished - 2014

Keywords

  • glycemic control
  • diabetes complications
  • metabolic memory
  • trajectory
  • DMIDS

Cite this

Chang, Hsing Yi ; Wahlqvist, Mark L. ; Liu, Wen Ling ; Lee, Meei-Shyuan ; Shin, Shyi Jang ; Li, Yu Sheng ; Chang, Chih Jen ; Chang, Chwen Tzuei ; Fuh, Mao Tsu ; Yang, Hung Jen ; Tai, Tong Yuan ; Hsu, Chih Cheng. / Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan : Accounting for behavioral therapy, nutrition education and therapeutics. In: Asia Pacific journal of clinical nutrition. 2014 ; Vol. 23, No. 4. pp. 592-606.
@article{056f0d9b0101445f8bc70e874aa618d3,
title = "Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan: Accounting for behavioral therapy, nutrition education and therapeutics",
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 (=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (=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.",
keywords = "glycemic control, diabetes complications, metabolic memory, trajectory, DMIDS",
author = "Chang, {Hsing Yi} and Wahlqvist, {Mark L.} and Liu, {Wen Ling} and Meei-Shyuan Lee and Shin, {Shyi Jang} and Li, {Yu Sheng} and Chang, {Chih Jen} and Chang, {Chwen Tzuei} and Fuh, {Mao Tsu} and Yang, {Hung Jen} and Tai, {Tong Yuan} and Hsu, {Chih Cheng}",
year = "2014",
doi = "10.6133/apjcn.2014.23.4.06",
language = "English",
volume = "23",
pages = "592--606",
journal = "Asia Pacific journal of clinical nutrition",
issn = "0964-7058",
publisher = "Wiley-Blackwell",
number = "4",

}

Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan : Accounting for behavioral therapy, nutrition education and therapeutics. / Chang, Hsing Yi; Wahlqvist, Mark L.; Liu, Wen Ling; Lee, Meei-Shyuan; Shin, Shyi Jang; Li, Yu Sheng; Chang, Chih Jen; Chang, Chwen Tzuei; Fuh, Mao Tsu; Yang, Hung Jen; Tai, Tong Yuan; Hsu, Chih Cheng.

In: Asia Pacific journal of clinical nutrition, Vol. 23, No. 4, 2014, p. 592-606.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Management trajectories in the type 2 diabetes Integrated Delivery System project in Taiwan

T2 - Accounting for behavioral therapy, nutrition education and therapeutics

AU - Chang, Hsing Yi

AU - Wahlqvist, Mark L.

AU - Liu, Wen Ling

AU - Lee, Meei-Shyuan

AU - Shin, Shyi Jang

AU - Li, Yu Sheng

AU - Chang, Chih Jen

AU - Chang, Chwen Tzuei

AU - Fuh, Mao Tsu

AU - Yang, Hung Jen

AU - Tai, Tong Yuan

AU - Hsu, Chih Cheng

PY - 2014

Y1 - 2014

N2 - 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 (=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (=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.

AB - 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 (=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (=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.

KW - glycemic control

KW - diabetes complications

KW - metabolic memory

KW - trajectory

KW - DMIDS

UR - http://www.scopus.com/inward/record.url?scp=84925546651&partnerID=8YFLogxK

U2 - 10.6133/apjcn.2014.23.4.06

DO - 10.6133/apjcn.2014.23.4.06

M3 - Article

C2 - 25516317

AN - SCOPUS:84925546651

VL - 23

SP - 592

EP - 606

JO - Asia Pacific journal of clinical nutrition

JF - Asia Pacific journal of clinical nutrition

SN - 0964-7058

IS - 4

ER -