A prospective randomized trial to evaluate effectiveness of diabetes management through an integrated delivery system (DMIDS) on glycemic and diet control in primary care setting in Taiwan.

• Main Authors: Huan-Sen Wang, 王煥森
• Other Authors: Shyi-Jang Shin1
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/36254435679935692572

碩士 === 高雄醫學大學 === 醫學研究所碩士班 === 96 === Objective The aim of this study was to evaluate the effectiveness of diabetes management in type 2 diabetes with regard to glycemic and diet control in primary care setting in Taiwan, and assess associations between nutrient intake and glycemic control. Methods We randomly assigned 154 adult patients with type 2 diabetes recruited from 5 primary care stations in Kaohsiung to intervention (n=75) or control group (n=79). The control subjects received the standard care, and intervention subjects additionally received diabetes education focusing on nutrition based on recommendation of American Diabetes Association by certified diabetes educators (2 registered dietitians) every three month. Results After 12 month follow up, we did not observed significant changes in clinical parameters in subjects with baseline glycosylated hemoglobin A1c (HbA1c)＜7%. On the other hand, in patients with baseline HbA1c≧7%, changes of fasting plasma glucose (mg/dl) (-13.4 vs 16.9, p=0.007), HbA1c (%) (-0.7 vs -0.2, p=0.034) and systolic blood pressure (mmHg) (0.5 vs 8.6, p=0.012) were significantly different between intervention and control groups. In these patients with baseline HbA1c≧7%, changes of energy and carbohydrate intake between the two groups were also significantly different (p＜0.05). Energy intake decreased by -291 (±347.2) Kcal/day in intervention and increased by 76.4 (±241.9) Kcal/day in control subjects (p＜0.001); carbohydrate intake decreased by -37.4 (±62.1) g/day in intervention group and increased by 13.4 (±48.5) g/day in the control (p＜0.001). However, we didn’t observed significant change in weight after 12 month intervention. After adjusting for possible confounders (age, gender, duration of diabetes, baseline weight, baseline HbA1c), increasing every 15 grams in carbohydrate intake (one carbohydrate counting) was significantly related to changes of HbA1c at increments of 0.14% (SE=0.03, p＜0.001). Conclusion Glycemic and dietary improvements can be achieved through diabetes education addressing nutrition aspects ≧7% in primary care setting in Taiwan. The improvements of glycemic status may be related to nutrition intervention and changes in diet such as amount of carbohydrate intake.