自助式健康管理模式对社区糖尿病患者生活方式的影响

目的了解居民自助式健康管理模式对社区糖尿病患者生活方式的影响。方法通过问卷调查了解129例社区糖尿病患者参加自助健康小屋检测前后生活方式的变化。结果社区糖尿病患者日常生活方式有明显变化,差异有统计学意义。结论居民自助式健康管理模式能提高社区糖尿病患者对健康重要性的认识,形成健康的生活方式,提高健康水平。     

Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes

The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6–9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (−4.02% of initial weight), decreased waist circumference (−3.12 cm), body fat (−1.75%), diastolic blood pressure (−3.49 mmHg), fasting glucose (−0.98 mmol/L) and HbA1c (−0.72%). During the 6–9 years postintervention period, they still had lower weight (−3.71 kg; −4.62% of initial weight), decreased waist circumference (−4.56 cm) and body fat (−2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6–9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.     

Accuracy of health examination results self-reported by Japanese participants

BACKGROUND: We evaluated the accuracy of self-reported health examination results by participants regarding their most recent public health examination by comparing their answers to the medical records in order to determine individual factors related to self-reporting accuracy. METHODS: The study was conducted at Settsu City in Osaka prefecture, Japan, in 1998 with 3570 participants who underwent general health examinations conducted by the municipal government. All participants were interviewed regarding their lifestyle as well as health guidance given at their previous examination, after which their answers were compared with the data from their medical records. The adjusted odds ratio (OR) for providing accurate self-reporting was calculated by multivariate logistic analyses. RESULTS: The frequency of accurate self-reporting was 49.4% and the overall Kappa value was 0.34. The OR for accurate self-reporting was lowest for those who have a poor lifestyle compared with those who had a good lifestyle. CONCLUSION: The accuracy of self-reported health examination results was poor. We concluded that information based on self-reported results of a health examination must be considered carefully. Further, lifestyle was found to be associated with the ability to accurately recall. Thus, methods for providing guidance to individuals with a poor life style must be carefully examined.     

糖尿病社区综合防治团队模式的实践效果评价

目的探讨社区综合防治团队模式对糖尿病患者血糖控制、用药依从性和糖尿病知识认知程度的影响。方法将180例糖尿病患者随机分为两组,对照组90例实施常规健康教育,观察组90例实施社区综合防治团队模式的健康教育,12个月后比较两组患者的血糖控制效果、用药依从性和知识知晓率。结果健康教育后,观察组空腹血糖、餐后2h血糖、糖化血红蛋白、三酰甘油、总胆固醇水平均低于对照组(P<0.05);观察组用药依从性显著高于对照组(P<0.05);观察组糖尿病知识认知程度评分显著高于对照组(P<0.05)。结论综合防治团队模式有效提高社区糖尿病患者用药依从性和糖尿病知识认知程度,改善血糖控制效果。     

Prevention of Type 2 Diabetes by Diet and Lifestyle Modification

Diabetes mellitus is an epidemic of our time. This disease affects nearly 150 million adults worldwide and nearly 11 million in the United States in 2000. Because of the prevalence of obesity and diabetes and associated vascular complications, preventing even a small proportion of cases would save thousands of lives and billions of dollars in healthcare costs and lost productivity. Researchers have made great strides in identifying many lifestyle and dietary factors associated with diabetes, but solidifying the scientific basis for prevention and control of this disease as well as implementation at a national level remains a difficult challenge. The literature on the influence of diet and lifestyle in the development of diabetes is reviewed here, with emphasis on epidemiologic data. We outline a systematic approach to primary and secondary prevention of this disease by evaluating and prioritizing risk factors for which intervention is effective and developing a framework for application of intervention strategies. Effective interventions must target not only the affected individuals but also families, workplaces, schools and communities. Prevention of this devastating disease calls for the identification of culture-sensitive measures that can be applied to the population in general and some high-risk minority groups in particular.     

Acculturation and healthy lifestyle among Latinos with diabetes

PURPOSE Latinos have a high prevalence of diabetes and disproportionately experience diabetic complications. We sought to examine the association of acculturation on healthy lifestyle habits among the Latino population in the United States with diabetes.METHODS We studied Latino adults (aged ≥20 years) with previously diagnosed diabetes in the 1999–2004 National Health and Nutrition Examination Survey (unweighted N = 467; weighted N = 1,957,778). Healthy lifestyle habits were those consistent with recommendations of the American Diabetes Association (ADA) regarding exercise, smoking, obesity, and diet. Acculturation was measured with the Short Acculturation Scale, a validated 5-item scale assessing use of the Spanish language. Logistic regression analyses of acculturation and healthy behaviors were computed controlling for access to care, demographics, and disease characteristics.RESULTS In bivariate analyses, compared with their less-acculturated counterparts, individuals who were more-acculturated to any extent were less likely to have a higher fiber intake (9.4% vs 35.4%, P = .001) and lower saturated fat intake (17.2% vs 46.5%, P = .03). More-acculturated individuals were more likely to report leisure time exercise (59.2% vs 19.3%, P <.001), whereas the proportion of individuals who smoked did not differ. In logistic regression analyses using the 1994 ADA dietary guidelines, more-acculturated individuals were less likely than their less-acculturated counterparts to meet dietary criteria for saturated fat consumption (odds ratio, 0.13; 95% confidence interval [CI], 0.04–0.41). When using the stricter 2006 ADA dietary guidelines, more-acculturated individuals were less likely to have recommended consumption of both saturated fat (odds ratio, 0.06; 95% CI, 0.02–0.20) and fiber (odds ratio, 0.19; 95% CI, 0.08–0.48). Acculturation did not significantly influence exercise and smoking status in logistic regression analyses.CONCLUSIONS These results suggest that acculturation among diabetic Latinos to the general US culture is associated with adoption of some less desirable dietary habits.     

Comparing self-reported health status and diagnosis-based risk adjustment to predict 1- and 2 to 5-year mortality

OBJECTIVES: To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. DATA SOURCES/STUDY SETTING: Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eight medical centers during fiscal year (FY) 1998, 35,337 of whom completed an 36-Item Short Form Health Survey for veterans (SF-36V) survey. STUDY DESIGN: We tested the ability of Diagnostic Cost Groups (DCGs), Adjusted Clinical Groups (ACGs), SF-36V Physical Component score (PCS) and Mental Component Score (MCS), and eight SF-36V scales to predict 1- and 2-5 year all-cause mortality. The additional predictive value of adding PCS and MCS to ACGs and DCGs was also evaluated. Logistic regression models were compared using Akaike's information criterion, the c-statistic, and the Hosmer-Lemeshow test. PRINCIPAL FINDINGS: The c-statistics for the eight scales combined with age and gender were 0.766 for 1-year mortality and 0.771 for 2-5-year mortality. For DCGs with age and gender the c-statistics for 1- and 2-5-year mortality were 0.778 and 0.771, respectively. Adding PCS and MCS to the DCG model increased the c-statistics to 0.798 for 1-year and 0.784 for 2-5-year mortality. CONCLUSIONS: The DCG model showed slightly better performance than the eight-scale model in predicting 1-year mortality, but the two models showed similar performance for 2-5-year mortality. Health self-report may add health risk information in addition to age, gender, and diagnosis for predicting longer-term mortality.     

社区健康教育在居家胰岛素治疗的 2 型糖尿病患者中的应用简

目的：探讨社区健康教育对居家使用胰岛素治疗的2型糖尿病（T2 diabetic mellitus, T2DM）患者的临床意义。方法对120例居家使用胰岛素治疗的T2DM患者进行专题讲座、血糖监测及专门辅导等规范化健康教育12个月,比较健康教育前后糖尿病相关知识知晓情况、医嘱依从性、空腹血糖等相关指标。结果健康教育12个月后糖尿病相关知识的知晓率比教育前明显提高（P＜0．01）;医嘱依从性从教育前的64．67％提高到教育后的92．67％,差异极显著（P＜0．01）;健康教育后的FPG、2h PG、HbA1c接近正常水平,与健康教育前比较差异极显著（P＜0．01）。结论社区健康教育对居家使用胰岛素治疗的2型糖尿病患者可促进血糖控制,延缓并发症,提高生活质量。     

An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes

Background: Education plays a key role in the development of self‐management skills for people with type 2 diabetes, although there is limited evidence for the use of video education. Aims: To develop a video‐based lifestyle education programme for people newly diagnosed with type 2 diabetes and to evaluate changes in knowledge, biomedical indices and quality of life. Methods: Forty‐two newly diagnosed type 2 diabetic subjects were recruited and randomly allocated to either a video education or control group. Data were collected at baseline and 6 months after the intervention. Subjects (43% male) had a mean (SD) age of 60.8 (9.6) years, weight 89.5 (15.5) kg, BMI 31.3 (5.1) kg m², glycated haemoglobin (A1c) 7.4 (1.7)%, total cholesterol 4.7 (1.2) mmol L^?1, high‐density lipoprotein cholesterol 1.15 (0.34) mmol L^?1, triglycerides 1.8 (1.0) mmol L^?1, low‐density lipoprotein cholesterol 2.8 (1.0) mmol L^?1, pedometer reading 5721 (3446) steps per day. There were 63.7% correct answers given to the ADKnowl questionnaire and the WHO‐5 Well‐Being score was 65.8%. Results: At 6 months, the intervention group showed increased knowledge compared to controls (74.3% versus 56.4% correct answers, P ≤ 0.0001). Although there were no significant differences in changes over 6 months between the two groups, the intervention group showed improvements in A1c (?0.7%, P = 0.024), total cholesterol (?0.5 mmol L^?1, P = 0.017), low‐density lipoprotein cholesterol (?0.5, P = 0.018) and increased physical activity measured by pedometer (1266 steps per day, P = 0.043) from baseline, with no significant changes in the control group. Conclusions: A brief video intervention increased diabetes knowledge amongst those newly diagnosed with type 2 diabetes and may comprise an effective way of directing education to such individuals.     

大连市1981—2013年居民糖尿病死亡趋势分析

目的了解辽宁省大连市1981—2013年居民糖尿病死亡趋势,为制定、评价预防控制措施提供科学依据。方法收集大连市1981—2013年居民心脑血管病死因监测数据,采用死亡数、粗死亡率、标化死亡率、死因构成比、年度变化百分比(APC)等指标对脑血管病死亡趋势进行统计学描述。结果1981—2013年大连市居民糖尿病粗死亡率为5.41/10万~40.59/10万,随年份增长呈上升趋势(χ_趋势²=3 178.60,P<0.01),APC为4.50(t=7.35,P<0.01);标化死亡率为6.77/10万~29.54/10万,随年份增长呈上升趋势(χ_趋势²=1 083 991.10,P<0.01),APC为0.40(t=0.50,P<0.01);糖尿病占总死亡的构成比为1.08%~6.33%,随年份增长呈上升趋势(χ_趋势²=2 286.19,P<0.01),2006年以后一直为大连市居民的第5位死因;1981—2013年男、女性居民糖尿病粗死亡率和标化死亡率分别为4.02/10万~33.14/10万和5.08/10万~23.33/10万、6.39/10万~48.16/10万和8.03/10万~36.17/10万,男、女性粗死亡率和标化死亡率均随年份增长呈下降趋势(均P<0.01);大连市居民糖尿病死亡率随年龄增长呈上升趋势(χ_趋势²=117 741.00,P<0.01),其中<40岁居民糖尿病死亡率较低,≥60岁居民死亡率明显升高。结论糖尿病死亡率上升迅速,绝对死亡数量大幅度增加,已成为大连市居民的主要死因之一。     

慢性病社区管理患者相关知识、态度、行为调查

目的 了解四川省成都市社区卫生服务中高血压糠尿病患者的知识、态度和行为情况.方法 运用简单随机抽样方法进行调查,采用描述性方法、X~2检验对高血压、糖尿病患者相应防治知识的知晓率、依从率、行为改变率进行分析.结果 成都市社区卫生服务中高血压患者对血压正常值的正确知晓率为48.9%,规律吃药的依从率为90.9%;行为改变率最高的是生活规律,为93.0%;糖尿病患者血糖正常值的正确知晓率为35.4%,规律吃药的依从率为94.2%,行为改变率最高的是运动量增加62.4%.待业下岗、个体经营的高血压糖尿病患者依从率较低(X~2=66.615,P<0.01;X~2=18.076,P<0.01).结论 高血压患者血压正常值的正确知晓率及行为改变率高于糖尿病患者;糖尿病患者在运动量的增加方面改善明显.     

Impact of a Digital Lifestyle Intervention on Diabetes Self-Management: A Pilot Study

The aim of this study was to provide preliminary evidence on the impact of the digital health application Vitadio on improving glycemic control in patients with type 2 diabetes mellitus. This was a 3-month, prospective, multicenter, open-label trial with an intraindividual control group. Participants received a digital lifestyle intervention. HbA1c levels were observed at 3 time points: retrospectively, at 3 months before app use; at baseline, at the start of usage; and 3 months after the start of use. In addition, changes in other metabolic parameters (fasting glucose, body weight, and waist circumference), patient reported outcomes (quality of life, self-efficacy, and depression), and data generated within the app (frequency of use, steps, and photos of meals) were evaluated. Repeated measures analysis of variance with the Bonferroni correction was used to assess the overall difference in HbA1c values between the intervention and the intraindividual control group, with p < 0.05 considered significant. Participants (n = 42) were 57 ± 7.4 years old, 55% male, and with a mean baseline HbA1c of 7.9 ± 1.0%. An average HbA1c reduction of −0.9 ± 1.1% (p < 0.001) was achieved. The digital health application was effective in significantly reducing body weight (−4.3 ± 4.5 kg), body mass index (−1.4 ± 1.5 kg/m²), waist circumference (−5.7 ± 15 cm), and fasting glucose (−0.6 ± 1.3 mmol/L). The digital therapy achieved a clinically meaningful and significant HbA1c reduction as well as a positive effect on metabolic parameters. These results provide preliminary evidence that Vitadio may be effective in supporting patient diabetes management by motivating patients to adopt healthier lifestyles and improving their self-management.     

Circulatory disease mortality and diabetes incidence in 27 families with Friedreich ataxia

Friedreich ataxia (FRA) is an autosomal recessive neuromuscular disorder in which nearly all affected homozygotes eventually develop significant cardiomyopathy and a substantial proportion also develop diabetes mellitus. Diabetes and early heart disease have been observed previously in close blood relatives of FRA patients. To test the hypothesis that FRA heterozygotes may have elevated rates of heart disease mortality and diabetes incidence, we compared the rates of these conditions in 1,191 adult blood relatives to those in 745 nonblood relative spouse controls in 27 families of FRA patients. We found no evidence for an excess of diabetes in the blood relatives. For three broad categories of circulatory disease mortality, the FRA blood relatives had significantly higher rates than the spouse controls. However, when each relative's prior probability of heterozygosity for the FRA gene was taken into account, the resulting estimates of relative risk of dying from circulatory disease for FRA heterozygotes compared to nonheterozygotes were not significantly elevated. Since the latter analysis provides the best test of the hypothesis, our data did not strongly support the hypothesis that FRA heterozygotes are at increased risk of cardiac death.     

Lifestyle and the development of dyslipidemia: a 4-year follow-up study of middle-aged Japanese Male Office Workers

To examine the lifestyle factors related to the development of dyslipidemia [low-density lipoprotein (LDL) cholesterol ≥ 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL, or triglyceride ≥ 250 mg/dL], 979 dyslipidemia-free Japanese male office workers aged 35 to 54 years were followed up for four years. The numbers of new incidence cases during the follow-up period were 216 for high LDL cholesterol level, 109 for low HDL cholesterol level, and 78 for high triglyceride level. From the Cox proportional hazards model, adjusted hazard ratios (HRs) for the incidence of high LDL cholesterol level were 0.62 [95% confidence interval (CI): 0.47-0.82] for consuming alcohol every day, 1.39 (95% CI: 1.10-1.77) for 5-kg/m² increase in body mass index (BMI), 1.45 (95% CI: 1.10-1.91) for snacking between meals every day, and 1.64 (95% CI: 1.18-2.30) for not eating vegetables every day. As for the incidence of low HDL cholesterol level, adjusted HRs for current cigarette smoking, consuming alcohol every day, and 5-kg/m² increase in BMI were 1.74 (95% CI: 1.17-2.59), 0.61 (95% CI: 0.41-0.89), and 1.79 (95% CI: 1.29-2.46), respectively. Adjusted HRs for the incidence of high triglyceride level were 1.73 (95% CI: 1.07-2.77) for current cigarette smoking, 1.74 (95% CI: 1.10-2.77) for 5-kg/m² increase in BMI, and 0.50 (95% CI: 0.27-0.90) for working 10 h per day or more. These results suggest that an increase in BMI, current cigarette smoking, and snacking between meals every day is closely associated with an increased risk of atherogenic lipid profiles. On the other hand, alcohol consumption and eating vegetables every day may have an anti-atherogenic effect on serum lipid profiles.     

青岛市2003-2007年居民糖尿病死亡分析

目的对2003-2007年山东省青岛市居民糖尿病死亡趋势和特征进行分析,为进一步做好社区糖尿病综合防治工作提供参考。方法采用国际死因分类法-10(ICD-10)进行死因分类,采用Access 2007及SPSS 15.0软件进行统计分析。结果近5年来青岛市糖尿病死亡率呈明显上升趋势,从2003年的12.20/10万上升至2007年的15.10/10万,并随年龄的增长而升高,50岁~组增加明显,80岁~组达最高;其中女性死亡率是男性的1.35倍,男性年均死亡增长率是女性的5.06倍;城市死亡率高于农村,农村年均死亡增长率高于城市,各区死亡率有较大差别。糖尿病患者根本死因为心脑血管疾病和肿瘤的死亡构成逐年增大。结论青岛市糖尿病死亡率逐年上升,成为影响居民健康的主要慢病之一。中老年女性和城市居民是防治的重点。     

Lifestyle intervention for prevention of diabetes: determinants of success for future implementation

Lifestyle interventions are reported to reduce the risk of type 2 diabetes in high-risk individuals after mid- and long-term follow-up. Information on determinants of intervention outcome and adherence and the mechanisms underlying diabetes progression are valuable for a more targeted implementation. Weight loss seems a major determinant of diabetes risk reduction, whereas physical activity and dietary composition may contribute independently. Body composition and genetic variation may also affect the response to intervention. Lifestyle interventions are cost-effective and should be optimized to increase adherence and compliance, especially for individuals in the high-risk group with a low socioeconomic status, so that public health policy can introduce targeted implementation programs nationwide. The aims of this review are to summarize the mid- and long-term effects of lifestyle interventions on impaired glucose tolerance and type 2 diabetes mellitus and to provide determinants of intervention outcome and adherence, which can be used for future implementation of lifestyle interventions.     

Effectiveness of a Lifestyle Modification Program Delivered under Real-World Conditions in a Rural Setting

Whilst there is considerable evidence to support the efficacy of physical activity and dietary interventions in disease and death prevention, translation of knowledge into practice remains inadequate. We aimed to examine the uptake, retention, acceptability and effectiveness on physical activity, physical function, sitting time, diet and health outcomes of a Healthy Eating Activity and Lifestyle program (HEAL^TM) delivered under real-world conditions. The program was delivered to 430 adults living across rural South Australia. Participants of the program attended weekly 2 h healthy lifestyle education and exercise group-based sessions for 8 weeks. A total of 47 programs were delivered in over 15 communities. In total, 548 referrals were received, resulting in 430 participants receiving the intervention (78% uptake). At baseline, 74.6% of participants were female, the mean age of participants was 53.7 years and 11.1% of participants identified as Aboriginal and/or Torres Strait Islander. Follow-up assessments were obtained for 265 participants. Significant improvements were observed for walking, planned physical activity, incidental physical activity, total physical activity, 30 s chair stand, 30 s arm curl, 6 min walk, fruit consumption and vegetable consumption, sitting time and diastolic blood pressure. Positive satisfaction and favourable feedback were reported. The healthy lifestyle program achieved excellent real-world uptake and effectiveness, reasonable intervention attendance and strong program acceptability amongst rural and vulnerable communities.     

Lifestyle and the development of hypertension: a 3-year follow-up study of middle-aged Japanese male office workers.

The association of lifestyle factors with the development of hypertension (blood pressure > or = 140/90 mmHg) over a 3-year follow-up period was studied in 949 hypertension-free Japanese male office workers aged 35 to 54 years. From the Cox proportional hazards model, age, alcohol intake, body mass index (BMI) and hours of work were independent factors associated with the development of hypertension. Adjusted hazard ratios for 5-year increases in age, daily consumption of alcohol, 5-kg/m2 increases in BMI and working 10 hours per day or more were 1.18 [95% confidence interval (CI) = 1.02-1.35]; 1.53 (CI = 1.14-2.05); 1.79 (CI = 1.38-2.33) and 0.58 (CI = 0.41-0.82), respectively. In the analysis using logistic regression, BMI was independently related to working 10 hours per day or more, controlling for other lifestyle factors. Adjusted odds ratio for 5-kg/m2 increase in BMI was 0.66 (CI = 0.49-0.88). These results suggest that the influences of long working hours on blood pressure are likely to be indirectly mediated through less overall obesity.     

Food intake and dietary glycaemic index in free-living adults with and without type 2 diabetes mellitus

A recent Cochrane review concluded that low glycaemic index (GI) diets are beneficial in glycaemic control for patients with type 2 diabetes mellitus (T2DM). There are limited UK data regarding the dietary GI in free-living adults with and without T2DM. We measured the energy and macronutrient intake and the dietary GI in a group (n = 19) of individuals with diet controlled T2DM and a group (n = 19) without diabetes, matched for age, BMI and gender. Subjects completed a three-day weighed dietary record. Patients with T2DM consumed more daily portions of wholegrains (2.3 vs. 1.1, P = 0.003), more dietary fibre (32.1 vs. 20.9 g, P < 0.001) and had a lower diet GI (53.5 vs. 57.7, P = 0.009) than subjects without T2DM. Both groups had elevated fat and salt intake and low fruit and vegetable intake, relative to current UK recommendations. CONCLUSIONS: Patients with T2DM may already consume a lower GI diet than the general population but further efforts are needed to reduce dietary GI and achieve other nutrient targets.