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: https://doi.org/10.1371/journal.pone.0226132



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.


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.


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


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