Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report


Autoři: Helmuth Haslacher aff001;  Hannelore Fallmann aff002;  Claudia Waldhäusl aff003;  Edith Hartmann aff002;  Oswald F. Wagner aff001;  Werner Waldhäusl aff002
Působiště autorů: Department for Laboratory Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria aff001;  Rehabilitation Clinic for Diabetes and Metabolic Diseases, Moorbad Neydharting, Neydharting, Neydharting, Austria aff002;  Department of Radiotherapy, Medical University of Vienna, Waehringer Guertel, Vienna, Vienna, Austria aff003;  Department of Medicine III, Medical University of Vienna, Waehringer Guertel, Vienna, Vienna, Austria aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226132

Souhrn

Background

Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed.

Aims and methods

This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400–600 kcal/d.

Results

At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital.

Conclusions

Our observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. To this end, ‘imprinting’ patients at a DRC could be of considerable help.

Klíčová slova:

Antihypertensives – Drug metabolism – Drug therapy – Glucose metabolism – Insulin


Zdroje

1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–21. Epub 2011/11/15. doi: 10.1016/j.diabres.2011.10.029 22079683

2. Lyssenko V, Laakso M. Genetic screening for the risk of type 2 diabetes: worthless or valuable? Diabetes Care. 2013;36 Suppl 2:S120–6. Epub 2013/08/02. doi: 10.2337/dcS13-2009 23882036

3. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50. Epub 2001/05/03. doi: 10.1056/NEJM200105033441801 11333990

4. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782–7. Epub 2001/12/14. doi: 10.1038/414782a 11742409

5. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–93. Epub 2003/01/31. doi: 10.1056/NEJMoa021778 12556541

6. Marathe PH, Gao HX, Close KL. American Diabetes Association Standards of Medical Care in Diabetes 2017. J Diabetes. 2017;9(4):320–4. Epub 2017/01/11. doi: 10.1111/1753-0407.12524 28070960

7. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89. Epub 2008/09/12. doi: 10.1056/NEJMoa0806470 18784090

8. Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52(11):2288–98. Epub 2009/08/06. doi: 10.1007/s00125-009-1470-0 19655124

9. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2017;391(10120):541–51. Epub 2017/12/10. doi: 10.1016/S0140-6736(17)33102-1 29221645

10. Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S. Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002. Clin Ther. 2006;28(3):388–95. Epub 2006/06/06. doi: 10.1016/j.clinthera.2006.03.005 16750453

11. Huber CA, Schwenkglenks M, Rapold R, Reich O. Epidemiology and costs of diabetes mellitus in Switzerland: an analysis of health care claims data, 2006 and 2011. BMC Endocr Disord. 2014;14:44. Epub 2014/06/05. doi: 10.1186/1472-6823-14-44 24894889

12. Kanavos P, van den Aardweg S, Schurer W. Diabetes expenditure, burden of disease and management in 5 EU countries London: LSE Health and Social Care; 2012 [2019-09-15]. Available from: http://www.lse.ac.uk/LSEHealthAndSocialCare/research/LSEHealth/MTRG/LSEDiabetesReport26Jan2012.pdf.

13. Bommer C, Heesemann E, Sagalova V, Manne-Goehler J, Atun R, Barnighausen T, et al. The global economic burden of diabetes in adults aged 20-79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017;5(6):423–30. Epub 2017/05/01. doi: 10.1016/S2213-8587(17)30097-9 28456416

14. Nahin R. Observational Studies and Secondary Data Analyses To Assess Outcomes in Complementary and Integrative Health Care NIH; 2012 [last updated 2018-03-26] [2019-04-16]. Available from: https://nccih.nih.gov/research/blog/observational-secondary.

15. Smith SA, Poland GA. Influenza and pneumococcal immunization in diabetes. Diabetes Care. 2004;27 Suppl 1:S111–3. Epub 2003/12/25.

16. Topp CW, Ostergaard SD, Sondergaard S, Bech P. The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. Epub 2015/04/04. doi: 10.1159/000376585 25831962

17. Update Ziegler D. 2014 on diabetic neuropathy. Der Diabetologe. 2014;10(5):376–83. doi: 10.1007/s11428-014-1195-7

18. Hirst JA, Stevens RJ, Farmer AJ. Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change. PLoS One. 2014;9(3):e92458. Epub 2014/03/29. doi: 10.1371/journal.pone.0092458 24667212

19. Fraser CG. Reference change values. Clin Chem Lab Med. 2011;50(5):807–12. Epub 2011/10/01. doi: 10.1515/CCLM.2011.733 21958344

20. Ricos C. Desirable Biological Variation Database specifications 2014 [2016-07-31]. Available from: http://www.westgard.com/biodatabase1.htm.

21. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (ncep) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel iii). JAMA. 2001;285(19):2486–97. doi: 10.1001/jama.285.19.2486 11368702

22. Wilding J, Godec T, Khunti K, Pocock S, Fox R, Smeeth L, et al. Changes in HbA1c and weight, and treatment persistence, over the 18 months following initiation of second-line therapy in patients with type 2 diabetes: results from the United Kingdom Clinical Practice Research Datalink. BMC Med. 2018;16(1):116. doi: 10.1186/s12916-018-1085-8 30008267

23. Haslacher H, Fallmann H, Waldhäusl C, Hartmann E, Wagner OF, Waldhäusl WK. Obesity: outcome of standardized life-style change in a rehabilitation clinic. An observational study. Diabetes Metab Syndr Obes. 2019;12:813–20. doi: 10.2147/DMSO.S197495 31213867

24. Haslacher H, Fallmann H, Waldhausl C, Hartmann E, Wagner OF, Waldhausl W. Type 1 diabetes care: Improvement by standardization in a diabetes rehabilitation clinic. An observational report. PLoS One. 2018;13(3):e0194135. Epub 2018/03/13. doi: 10.1371/journal.pone.0194135 29529063

25. Wu D, Li L, Liu C. Efficacy and safety of dipeptidyl peptidase-4 inhibitors and metformin as initial combination therapy and as monotherapy in patients with type 2 diabetes mellitus: a meta-analysis. Diabetes Obes Metab. 2014;16(1):30–7. Epub 2013/06/28. doi: 10.1111/dom.12174 23803146

26. Pi-Sunyer X. The Look AHEAD Trial: A Review and Discussion Of Its Outcomes. Curr Nutr Rep. 2014;3(4):387–91. doi: 10.1007/s13668-014-0099-x 25729633

27. Sjostrom L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden A, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304. Epub 2014/06/11. doi: 10.1001/jama.2014.5988 24915261

28. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med. 2017;377(12):1143–55. doi: 10.1056/NEJMoa1700459 28930514

29. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512 11832527

30. Harris SB, Petrella RJ, Leadbetter W. Lifestyle interventions for type 2 diabetes. Relevance for clinical practice. Can Fam Physician. 2003;49:1618–25. 14708927

31. Henry RR, Scheaffer L, Olefsky JM. Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1985;61(5):917–25. Epub 1985/11/01. doi: 10.1210/jcem-61-5-917 4044780

32. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580–91. Epub 2008/02/08. doi: 10.1056/NEJMoa0706245 18256393

33. Chen S, Zhang Q, Dai G, Hu J, Zhu C, Su L, et al. Association of depression with pre-diabetes, undiagnosed diabetes, and previously diagnosed diabetes: a meta-analysis. Endocrine. 2016;53(1):35–46. Epub 2016/02/03. doi: 10.1007/s12020-016-0869-x 26832340

34. Resnick HE, Howard BV. Diabetes and cardiovascular disease. Annu Rev Med. 2002;53:245–67. Epub 2002/01/31. doi: 10.1146/annurev.med.53.082901.103904 11818473

35. King P, Peacock I, Donnelly R. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643–8. doi: 10.1046/j.1365-2125.1999.00092.x 10594464

36. Juarez D, Goo R, Tokumaru S, Sentell T, Davis J, Mau M. Association Between Sustained Glycated Hemoglobin Control and Healthcare Costs. Am J Pharm Benefits. 2013;5(2):59–64. Epub 2014/01/01. 24379909

37. Xin Y, Davies A, McCombie L, Briggs A, Messow C-M, Grieve E, et al. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight-Plus weight management programme within a primary care randomized controlled trial. Diabet Med. 2019; in press. doi: 10.1111/dme.13981 31026353


Článek vyšel v časopise

PLOS One


2019 Číslo 12