Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Systematic medical assessment, referral and treatment for diabetes care in China using lay family health promoters: protocol for the SMARTDiabetes cluster randomised controlled trial Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program A culturally competent intervention of education and care for black women with type 2 diabetes. HeLP-Diabetes: randomised controlled trial protocol Family intervention to control type 2 diabetes: a controlled clinical trial. A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the Let's Prevent Diabetes cluster randomised controlled trial. Engagement, Retention, and Progression to Type 2 Diabetes: A Retrospective Analysis of the Cluster-Randomised "Let's Prevent Diabetes" Trial Prevalence of risk for type 2 diabetes in school children. Outcome of intensive integrated intervention in participants with impaired glucose regulation in China Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice. Willingness to pay for improvements in chronic long-acting insulin therapy in individuals with type 1 or type 2 diabetes mellitus. Effects of a 12-week aerobic training on glycemic control in type 2 diabetes mellitus male patients. DiaSurg 2 trial - surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial - DRKS00004550 Web-based telemedicine for management of type 2 diabetes through glucose uploads: a randomized controlled trial.
AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs Background Type 2 diabetes ( T2DM ) affects 113.9 million people in China , the largest number of any country in the world ( JAMA 310:948–59 , 2013 ) . T2DM prevalence has risen dramatically from around 1 % in the 1980s to now over 10 % and is expected to continue rising . Despite the growing disease burden , few people with T2DM are achieving adequate management targets to prevent complications . Health system infrastructure in China is struggling to meet these gaps in care , and innovative , cost-effective and affordable solutions are needed . One promising strategy that may be particularly relevant to the Chinese context is improving support for lay family members to care for their relatives with T2DM . Methods We hypothesise that an interactive mobile health management system can support lay family health promoters ( FHP ) and healthcare staff to improve clinical outcomes for family members with T2DM through medical assessment , regular monitoring , lifestyle advice and the prescribing of guidelines recommended medications . This intervention will be implemented as a cluster r and omised controlled trial involving 80 communities ( 40 communities in Beijing and 40 rural villages in Hebei province ) and 2000 people with T2DM . Outcome analyses will be conducted blinded to intervention allocation . The primary outcome is the proportion of patients achieving ≥2 “ ABC ” goals ( HbA1c < 7.0 % , blood pressure ( BP ) < 140/80 mmHg and LDL cholesterol < 100 mg/dl or 2.6 mmol/L ) at the end of follow-up ( Diabetes Care 36(Supplement 1):S11-S66 , 2013 ) . Secondary outcomes include the proportion of patients achieving individual ABC targets ; mean changes in HbA1c , BP , LDL , renal function ( serum creatinine and urinary albumin ) , body mass index , quality of life ( QOL , EQ-5D ) , and healthcare utilisation from baseline ; and cost-effectiveness/utility of intervention . Trial outcomes will be accompanied by detailed process and economic evaluations . Discussion The Chinese government has prioritised prevention and treatment of diabetes as 1 of 11 National Basic Public Health Services . Despite great promise for mHealth interventions to improve access to effective health care , there remains uncertainty about how this can be successfully achieved . The findings are likely to inform policy on a scalable strategy to overcome sub-optimal access to effective health care in China . Trial registration Clinical trials.gov Background India currently has more than 60 million people with Type 2 Diabetes Mellitus ( T2DM ) and this is predicted to increase by nearly two-thirds by 2030 . While management of those with T2DM is important , preventing or delaying the onset of the disease , especially in those individuals at ‘ high risk ’ of developing T2DM , is urgently needed , particularly in re source -constrained setting s. This paper describes the protocol for a cluster r and omised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala , India . Methods / design A total of 60 polling booths are r and omised to the intervention arm or control arm in rural Kerala , India . Data collection is conducted in two steps . Step 1 ( Home screening ) : Participants aged 30–60 years are administered a screening question naire . Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic ( Step 2 ) . At the mobile clinic , participants complete question naires , undergo physical measurements , and provide blood sample s for biochemical analysis . Participants identified with T2DM at Step 2 are excluded from further study participation . Participants in the control arm are provided with a health education booklet containing information on symptoms , complications , and risk factors of T2DM with the recommended levels for primary prevention . Participants in the intervention arm receive : ( 1 ) eleven peer-led small group sessions to motivate , guide and support in planning , initiation and maintenance of lifestyle changes ; ( 2 ) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors , prevention and management ; ( 3 ) a participant h and book containing information primarily on peer support and its role in assisting with lifestyle modification ; ( 4 ) a participant workbook to guide self-monitoring of lifestyle behaviours , goal setting and goal review ; ( 5 ) the health education booklet that is given to the control arm . Follow-up assessment s are conducted at 12 and 24 months . The primary outcome is incidence of T2DM . Secondary outcomes include behavioural , psychosocial , clinical , and biochemical measures . An economic evaluation is planned . Discussion Results from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other re source -constrained setting s . Trial registration Australia and New Zeal and Clinical Trials Registry : ACTRN12611000262909 This article reports on the development and pilot feasibility testing of a culturally competent intervention of education and care for black women with type 2 diabetes mellitus ( T2DM ) . Using a one group , pretest posttest quasi-experimental design , the intervention was tested with a convenience sample of 25 community black women with T2DM . The conceptual basis , process , and content of the intervention as well as the feasibility and acceptability of study material s and methods are described . Significant improvements from baseline to 3 months were observed in measures of glycemic control , weight , body mass index , and diabetes-related emotional distress . The findings suggest that a culturally sensitive intervention of nurse practitioner diabetes care and education is beneficial for black women with T2DM , result ing in program attendance , kept appointments , improved glycemic control and weight , and decreased diabetes-related emotional distress Background Type 2 Diabetes Mellitus ( T2DM ) is common , affecting nearly 400 million people worldwide . Achieving good health for people with T2DM requires active self-management ; however , uptake of self-management education is poor , and there is an urgent need to find better , more acceptable , cost-effective methods of providing self-management support . Web-based self-management support has many potential benefits for patients and health services . The aim of this trial is to determine the effectiveness and cost-effectiveness of a web-based self-management support programme for people with T2DM . Methods This will be a multi-centre individually r and omised controlled trial in primary care , recruiting adults with T2DM who are registered with participating general practice s in Engl and . Participants will be r and omised to receive either an evidence -based , theoretically informed , web-based self-management programme for people with T2DM which addresses medical , emotional , and role management , called Healthy Living for People with type 2 Diabetes ( HeLP-Diabetes ) or a simple information website . The joint primary outcomes are glycated haemoglobin ( HbA1c ) and diabetes-related distress , measured by the Problem Areas In Diabetes ( PAID ) question naire . Secondary outcomes include cardiovascular risk factors , depression and anxiety , and self-efficacy for self-management of diabetes . Health economic data include health service use , costs due to the intervention , and EQ-5D for calculation of Quality Adjusted Life Years ( QALYS ) . Data will be collected at baseline , 3 months and 12 months , with the primary endpoint at 12 months . Practice nurses , blinded to patient allocation , collect clinical data ; patients complete online question naires for patient reported measures . A sample size of 350 recruited participants allows for attrition of up to 15 % and will provide 90 % power of detecting at a 5 % significance level a true average difference in the PAID score of 4.0 and 0.25 % change in HbA1c ( both small effect sizes ) . The analysis will follow a pre-specified analysis plan , based on comparing the groups as r and omised ( intention-to-treat ) . Discussion The findings of this trial are likely to be of interest to policy makers , clinicians , and commissioners , all of whom are actively seeking additional forms of self-management support for people with T2DM.Trial registration The Trial Registration number is IS RCT N02123133 ; date of registration 14.2.13 PURPOSE Chilean patients with type 2 diabetes mellitus ( T2DM ) have a low rate of blood sugar control . We studied the effectiveness of a culturally sensitive family oriented intervention design ed to improve metabolic control in primary care patients with uncontrolled T2DM . METHODS Patients with T2DM from three primary care clinics in Santiago , Chile were r and omly selected for inclusion if they had a recent HbA1c ≥7 % , were between 18 and 70 years old and lived with a family member . Patients from one clinic received the family oriented intervention ;  patients from the other two ( control ) clinics received st and ard care . The intervention involved family members in care and included family counselling during clinic visits , family meetings and home visits . The primary outcome was HbA1c , measured at 6 and 12 months . RESULTS A total of 243 patients were enrolled and 209 ( 86 % ) completed the study . The intervention was fully administered to only 34 % of patients in the intervention clinic . The reduction in the HbA1c from baseline to 12 months was not significantly different between clinics . During the second 6-month period , when the intervention was more intensive , the patients in the intervention clinic significantly improved their HbA1c ( P < 0.001 ) compared to the control patients . CONCLUSIONS A family intervention for the control of T2DM was associated with a significant reduction in HbA1c when the intervention was provided . Incomplete implementation , low statistical power and potential confounding variables between groups could be some of the main factors that explain the lack of difference between clinics in the 12-month period Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus ( T2DM ) . This pilot study examined a 12-week church-based culturally targeted diabetes self-management education ( DSME ) intervention for middle-aged and older African Americans with T2DM . Quantitative data were collected at baseline and at 12 weeks and included question naires and anthropometric measures . There were significant increases in medication adherence ( p = .006 ) , healthy eating ( p = .009 ) , and foot care adherence ( p = .003 ) . The intervention had a clinical ly significant effect on systolic blood pressure , blood lipids , physical activity , and waist circumference . Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM . The authors discuss the value of community-based interventions that target behavioural changes in population s of chronically ill patients , particularly those who historically have been disenfranchised and /or underserved OBJECTIVES Prevention of type 2 diabetes ( T2DM ) is a priority in healthcare , but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting . We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM  in people with pre-diabetes . MATERIAL S AND METHODS Forty-four general practice s were r and omised to receive either st and ard care or a 6hour group structured education programme with an annual refresher course , and regular phone contact . Participants were followed up for 3years . The primary outcome was progression to T2DM . RESULTS Eight hundred and eighty participants were included ( 36 % female , mean age 64years , 16 % ethnic minority group ) ; 131 participants developed T2DM . There was a non-significant 26 % reduced risk of developing T2DM in the intervention arm compared to st and ard care ( HR 0.74 , 95 % CI 0.48 , 1.14 , p=0.18 ) . The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant ( HR 0.65 , 0.41 , 1.03 , p=0.07 ) . There were statistically significant improvements in HbA1c ( -0.06 , -0.11 , -0.01 ) , LDL cholesterol ( -0.08 , -0.15 , -0.01 ) , sedentary time ( -26.29 , -45.26 , -7.32 ) and step count ( 498.15 , 162.10 , 834.20 ) when data were analysed across all time points . CONCLUSIONS This study suggests that a relatively low re source , pragmatic diabetes prevention programme result ed in modest benefits to biomedical , lifestyle and psychosocial outcomes , however the reduction to the risk of T2DM did not reach significance . The findings have important implication s for future research and primary care Background Prevention of  type 2 diabetes mellitus  ( T2DM ) is a global priority . Let ’s Prevent Diabetes is a group-based diabetes prevention programme ; it was evaluated in a cluster-r and omised trial , in which the primary analysis showed a reduction in T2DM ( hazard ratio [ HR ] 0.74 , 95 % CI 0.48–1.14 , p = 0.18 ) . We examined the association of engagement and retention with the Let ’s Prevent Diabetes prevention programme and T2DM incidence . Methods and Findings We used data from a completed cluster-r and omised controlled trial including 43 general practice s r and omised to receive either st and ard care or a 6-h group structured education programme with an annual refresher course for 2 y. The primary outcome was progression to T2DM at 3 y. The characteristics of those who attended the initial education session ( engagers ) versus nonengagers and those who attended all sessions ( retainers ) versus nonretainers were compared . Risk reduction of progression to T2DM by level of attendance was compared to st and ard care . Eight hundred and eighty participants were recruited , with 447 to the intervention arm , of which 346 ( 77.4 % ) were engagers and 130 ( 29.1 % ) were retainers . Retainers and engagers were more likely to be older , leaner , and nonsmokers than nonretainers/nonengagers . Engagers were also more likely to be male and be from less socioeconomically deprived areas than nonengagers . Participants who attended the initial session and at least one refresher session were less likely to develop T2DM compared to those in the control arm ( 30 people of 248 versus 67 people of 433 , HR 0.38 [ 95 % CI 0.24–0.62 ] ) . Participants who were retained in the programme were also less likely to develop T2DM compared to those in the control arm ( 7 people of 130 versus 67 people of 433 , HR 0.12 [ 95 % CI 0.05–0.28 ] ) . Being retained in the programme was also associated with improvements in glucose , glycated haemoglobin ( HbA1c ) , weight , waist circumference , anxiety , quality of life , and daily step count . Given that the data used are from a clinical trial , those taking part might reflect a more motivated sample than the population , which should be taken into account when interpreting the results . Conclusions This study suggests that being retained/engaged in a relatively low-re source , pragmatic diabetes prevention programme for those at high risk is associated with reductions in the progression to T2DM in comparison to those who receive st and ard care . Nonengagers and nonretainers share similar high-risk traits . Service providers of programmes should focus on reaching these hard-to-reach groups . Trial Registration Clinical Trials.gov IS RCT According to the Centers for Disease Control and Prevention , 1 in 3 children born in 2000 in the United States will become diabetic . The odds are higher for African American and Hispanic children as nearly 50 % of them will develop diabetes . R and om screening is not effective in identifying children at risk for type 2 diabetes mellitus ( T2DM )  ; therefore , there is a need to apply screening strategies that guide the development of appropriate primary prevention efforts . To assess the prevalence of risk factors for T2DM , 1066 fifth- grade children were screened using American Diabetes Association guidelines . Overall , 22.6 % were found at risk ; African American and Hispanic children were almost 8 times more likely to be at risk when compared to Caucasians ( odds ratio = 7.41 and 7.87 ) . Children who reported watching TV/playing video games 2 or more hours/day were 73 % more likely to be at risk . Children identified to be at risk were referred to their primary care provider and were invited to participate in a counseling session . The environmental risk factors for T2DM identified in this study are modifiable and should be targeted in preventive interventions at the school and community level to reduce overweight and consequently prevent T2DM in children , especially among minority children Introduction This study investigated the outcomes and identified influencing factors of intensive integrated intervention over 2 years in Chinese patients with impaired glucose regulation ( IGR ) . Methods Adults in Beijing , China , were screened for IGR using the 75 g oral glucose tolerance test . Participants with IGR received lifestyle and health education ; those who still had IGR after 1 year were r and omly assigned to either a routine care group or to an intensive integrated intervention group . Results Of 2344 adults screened , 463 had IGR . Of these , 210 adults had IGR after 1 year and were therefore recruited and r and omized to an intensive integrated intervention group ( n=106 ) or a control group ( n=104 ) . The percentage of patients who reached the set targets of plasma glucose , blood pressure , body mass index , or triglycerides was significantly higher in the intensive integrated intervention group . None of the patients within the intensive integrated intervention group progressed to diabetes , whereas eight ( 9.3 % ) cases of the control group developed type 2 diabetes mellitus ( T2DM ) . Logistic regression analysis showed that both an increase in waist circumference and systolic blood pressure ( SBP ) were positively correlated with the development of T2DM , whereas improvement in islet beta cell function was negatively correlated with the development of T2DM . Conclusions Intensive integrated intervention may significantly decrease the conversion rate of IGR to T2DM , and increase the conversion ratio to normal glucose tolerance . The increase of waist circumference or SBP and the deterioration of islet beta cell function may be important risk factors for progression from prediabetes to diabetes Background African Americans with Type 2 diabetes ( T2DM ) have higher prevalence of diabetes , poorer metabolic control , and greater risk for complications and death compared to American Whites . Poor outcomes in African Americans with T2DM can be attributed to patient , provider , and health systems level factors . Provider and health system factors account for < 10 % of variance in major diabetes outcomes including hemoglobin A1c ( HbA1c ) , lipid control , and re source use . Key differences appear to be at the patient level . Of the patient level factors , consistent differences between African Americans and American Whites with T2DM have been found in diabetes knowledge , self-management skills , empowerment , and perceived control . A variety of interventions to improve diabetes self-management have been tested including : 1 ) knowledge interventions ; 2 ) lifestyle interventions ; 3 ) skills training interventions ; and 4 ) patient activation and empowerment interventions . Most of these interventions have been tested individually , but rarely have they been tested in combination , especially among African Americans who have the greatest burden of diabetes related complications . This study provides a unique opportunity to address this gap in the literature . Methods / Design We describe an ongoing four-year r and omized clinical trial , using a 2 × 2 factorial design , which will test the efficacy of separate and combined telephone-delivered , diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM ( HbA1c ≥ 9 % ) . Two-hundred thirty-two ( 232 ) male and female African-American participants , 18 years of age or older and with an HbA1c ≥ 9 % , will be r and omized into one of four groups for 12-weeks of phone interventions : ( 1 ) an education group , ( 2 ) a motivation/skills group , ( 3 ) a combined group or ( 4 ) a usual care/general health education group . Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control . Our primary hypothesis is that among African Americans with poorly controlled T2DM , patients r and omized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group . Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM.Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT00929838 ) RATIONALE , AIMS AND OBJECTIVES Peer review groups are considered helpful for quality improvement in primary care . An interactive educational programme for small peer groups was developed , focusing on the implementation of newly developed treatment guidelines . The aim is to evaluate the effect of the programme on adherence to treatment guidelines in general practice . METHODS A cluster r and omized trial using a balanced incomplete block design was used ; one arm received a programme on treatment of chronic heart failure ( CHF ) , the other on hypertension treatment in diabetes mellitus type 2 ( T2DM ) . A r and om sample of 10 CHF and 10 T2DM patients per GP was drawn , for whom data were extracted from electronic patient records 1 years before and 6 months after the intervention . The outcomes were prescribing of ACE inhibitors , and antihypertensive treatment in T2DM . The effect was analysed separately for both programmes using multilevel regression models . RESULTS All 27 peer review groups in one region in the Netherl and s were r and omized , of which 16 participated . No significant effects were observed in the CHF group or in the T2DM group . The opportunity for change was limited , as only 53 % of the CHF patients and 60 % of the T2DM patients had a contact with their GP between the intervention and follow-up measurement . CONCLUSION The peer review programme was not successful for changing the treatment of chronic patients , although the programme focused on dealing with barriers perceived by the participants . Not all problems perceived can be solved in a peer group discussion BACKGROUND Long-acting insulin treatments with varying clinical benefits are currently available for patients with type 1 diabetes mellitus ( T1DM ) and type 2 diabetes mellitus ( T2DM ) . The current evidence base demonstrates the efficacy of treatments , but it is critical also to underst and patient preferences regarding treatments and how they are determined . OBJECTIVE This study aim ed to measure the willingness to pay ( WTP ) of individuals with diabetes in the United Kingdom for different attributes of long-acting insulin therapy . METHODS A survey based on discrete choice experiment methodology was developed to elicit the preferences and values of adults with T1DM or insulin-dependent T2DM regarding different aspects of their therapy . Participants were presented with a series of 27 paired choices and asked which they preferred . WTP values were calculated for relevant attribute levels . RESULTS A total of 252 participants completed the question naire ( 52 % response rate ) ; 143 had T1DM and 109 had insulin-treated T2DM . The highest WTP values in participants with T1DM were avoiding 2-kg or 4-kg weight gain ( £ 29 and £ 58 , respectively ) , avoiding major difficulties with the injection device ( £ 49 ) , increasing the number of days per week when blood glucose levels are in the target range from 2 to 6 ( £ 40 ) , reducing the number of daily injections from 3 to 1 ( £ 39 ) , and avoiding nighttime hypoglycemia ( £ 33 ) . In participants with T2DM , similar factors had the highest WTP . CONCLUSIONS This is the first study to assess WTP  for long-acting insulin therapy and could have implication s for future guidelines on diabetes management , however some limitations , notably in sample selection , could affect generalizability of the results . In both T1DM and T2DM , the highest WTP values were for avoidance of weight gain , and reduction in the number of injections and hypoglycemia T 2 diabetes mellitus ( T2DM ) is a metabolic disease affecting the metabolism of carbohydrates , proteins and lipids due to initial insulin resistance at the cellular levels followed by progressive insulin deficiency . The consequence of that is gradual increment of serum blood glucose , which binds independent of the enzymes to the proteins in the blood , as well as the tissue proteins ; one of these measurable protein is the red blood cells hemoglobin , which enabled the clinician to assess diabetes control by the percentage of glycosylation of this protein every 3 months , which correlates well to the other tissue involvement and the disease control . Diabetes-related complications are related to the micro and macro vascular derangement due to glycosylated protein in these vessels tissues , leading to nephropathy , retinopathy , neuropathy , myocardial infa rct ion , stroke , and death found to be more frequent and seen at earlier age.1 Estimate of global T2DM indicates that diabetes now affects 246 million people worldwide , and is expected to affect approximately 380 million by 2025 , representing 7.1 % of the world adult population .2 The Kingdom of Saudi Arabia ( KSA ) has one of the highest prevalence of T2DM worldwide since the percentage of diabetes mellitus is estimated to be 23.7 % of the overall population .3 Structured exercise interventions have been shown to be at least as efficacious as the pharmaceutical agents for improving glycemic control.4 Most people with T2DM do not do enough physical activity to benefit their health , and in comparison with the general population , people with diabetes experience a higher frequency of relapse to sedentary behavior.5 Our primary objective is to investigate the effects of supervised aerobic exercise on glycemic control , the glycosylated hemoglobin ( HbA1c ) level , as well as the effect on medication doses adjustments , before and after the study in T2DM Saudi male patients . Our secondary objective was to assess its effect on their lipid profile . This study was performed as collaboration between the Department of Physical Education at the King Fahd University of Petroleum and Minerals ( KFUPM ) and King Fahd Hospital of the University ( KFHU ) , University of Dammam from July to October 2012 . Fifty male patients registered in the diabetes clinic records at KFHU , Al-Khobar , KSA were r and omly selected using the stratified r and om sampling and pooled in the study for inclusion and exclusion criteria filtering . Twenty-four patients diagnosed with T2DM , age range of 25 - 55 years ( 43.86±10.3 years ) were selected to be enrolled in the study . Their medication profiles were documented at the beginning and at the end of the program from their medical files . Diet and lifestyle of patients were not controlled by the study . We excluded patients known to have cardiovascular disease , hypertension , retinopathy , neuropathy , bronchial asthma , arthritis , and morbidly obese . We also excluded those who were involved in any physical exercise program or subjects living very far from KFUPM , the site of the physical exercise . After initial screening and baseline assessment s , all 24 subjects were r and omly allocated to 2 different groups namely ; intervention group ( n=12 ) and control group ( n=12 ) . The exercise group subjects signed a written informed consent after being informed regarding all possible risks associated with exercise training programme .  Comprehensive clinical examination , as well as laboratory testing and fitness assessment were performed for each subject before participation in the exercise training programme , as well as at the end of the programme . All subjects went through one week of familiarization before the start of the programme . After a few weeks , 2 subjects withdrew from the intervention group due to personal reasons . Only 10 subjects completed the 12 weeks of the exercise training programme  . The exercise training programme was given at the fitness centre of KFUPM . The entire duration of the 12-week exercise training programme was closely supervised by 2 qualified personnel . Attendance was verified every day through direct observation and documented records . Exercise data were recorded every day on a chart . The exercise session includes running or walking on treadmill , and cycling on bicycle ergometer . We provided 10 minutes of warming up period and 10 minutes of cooling down period in each exercise session . Each participant had to check his blood glucose levels before and after the exercise . Subjects performed exercise 3 times per week on alternate days with no more than a 2-day gap . The training was design ed to provide an alternate day as a replacement for missed training sessions during the week . Subjects started with training intensity of 40 - 50 % of maximum heart rate Brief Background Type 2 diabetes mellitus ( T2DM ) is a disease with high prevalence , associated with severe co-morbidities as well as being a huge burden on public health . It is known that glycemic control decreases long-term morbidity and mortality . The current st and ard therapy for T2DM is medical treatment . Several r and omized controlled trials ( RCTs ) performed in obese patients showed remission of T2DM after bariatric surgery . Recent RCTs have shown bariatric procedures to produce a similar effect in non-morbidly and non-severely obese , insulin-dependent T2DM patients suggesting procedures currently used in bariatric surgery as new therapeutical approach in patients with T2DM . This study aims at investigating whether Roux-en-Y gastric bypass ( RYGB ) is an efficient treatment for non-severely obese T2DM patients in terms of preventing long-term complications and mortality . Methods The DiaSurg 2 trial is a multicenter , open r and omized controlled trial comparing RYGB including st and ardized medical treatment if needed to exclusive st and ardized medical treatment of T2DM ( control group ) . The primary endpoint is a composite time-to-event endpoint ( cardiovascular death , myocardial infa rct ion , coronary bypass , percutaneous coronary intervention , non-fatal stroke , amputation , surgery for peripheral atherosclerotic artery disease ) , with a follow-up period of 8 years . Insulin-dependent T2DM patients aged between 30 and 65 years will be included and r and omly assigned to one of the two groups . The experimental group will receive RYGB and , if needed , st and ardized medical care , whereas the control group will receive exclusive st and ardized medical care , both according to the national treatment guidelines for T2DM . Statistical analysis is based on Cox proportional hazards regression for the intention-to-treat population . Assuming a loss to follow-up rate of 20 % , 200 patients will be r and omly allocated to the comparison groups . A total sample size of n = 400 is sufficient to ensure 80 % power in a two-tailed significance test at alpha = 5 % . Discussion The DiaSurg2 trial will yield long-term data ( 8 years ) on diabetes-associated morbidity and mortality in patients with insulin-dependent T2DM receiving either RYGB or st and ardized medical care . Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004550 AIMS To evaluate the feasibility and effectiveness of a telemedicine system based on internet in the follow-up of patients with type 2 diabetes mellitus ( T2DM ) . METHODS A prospect i ve r and omized telemedicine study with two parallel groups was design ed . 114 patients diagnosed T2DM were r and omly divided into telemedicine group and traditional face-to-face visit group as control . 57 cases were included for each group . 108 patients completed the trial , in which 53 cases in telemedicine group and 55 cases in control group . Patients in telemedicine group were taught to use telemedicine software to upload their blood glucose and other metabolic information at home at least every 2 weeks , and the research ers gave proper advices according to patients ' key behaviors . The telemedicine interval is 3 months . RESULTS Compared to control group , telemedicine group exhibited better HbA1c and fasting blood glucose controlling ( P < 0.05 ) . Moreover , telemedicine intervention decreased hypoglycemia risk ( P = 0.044 ) , and contributed to levels of HbA1c less than 7 % which is the target of our study ( P = 0.049 ) . CONCLUSIONS Telemedicine system can provide a tighter glycemic control for the treatment of T2DM patients , especially in cases with difficulties to access to the medical centre
Through this review , we found two key health system barriers to effective T2DM care and management : financial constraints faced by the patient and limited access to health services and medication .
This review points to the importance of reducing , or possibly eliminating , out-of-pocket costs for diabetes medication and self-monitoring supplies .
BACKGROUND Type 2 Diabetes Mellitus ( T2DM ) is reported to affect one in 11 adults worldwide , with over 80 % of T2DM patients residing in low-to-middle-income countries .
Health systems play an integral role in responding to this increasing global prevalence , and are key to ensuring effective diabetes management .
We conducted a systematic review to examine the health system-level factors influencing T2DM awareness , treatment , adherence , and control .