A culturally competent intervention of education and care for black women with type 2 diabetes. Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. Systematic medical assessment, referral and treatment for diabetes care in China using lay family health promoters: protocol for the SMARTDiabetes cluster randomised controlled trial Family intervention to control type 2 diabetes: a controlled clinical trial. An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice. Cluster randomised controlled trial of a peer-led lifestyle intervention program: study protocol for the Kerala diabetes prevention program Metformin Based Dual-Combination Therapies in Drug Naïve Type 2 Diabetic Patients Ngāti and healthy: translating diabetes prevention evidence into community action Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study 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 Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients A multifaceted school-based intervention to reduce risk for type 2 diabetes in at-risk youth. Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review HeLP-Diabetes: randomised controlled trial protocol Effects of a 12-week aerobic training on glycemic control in type 2 diabetes mellitus male patients. 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.
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 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 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 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 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 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 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 There is an explosive growth of type 2 diabetes mellitus ( T2DM ) in South Korea . According to Korea National Health and Nutritional Examination Survey performed in 2011 , the prevalence of diabetes among the population of 30 years and old is 12.4 % , and the number of patients with T2DM is expected to reach 6 million by 2050 [ 1 ] . Through studies such as UK Prospect i ve Diabetes Study , it has been well established that aggressive glycemic control in patients with newly diagnosed T2DM reduces microvascular and macrovascular complications of the disease [ 2 ] . Therefore , it is important to diagnose and treat T2DM in early phase . Several institutions have suggested target glycemic goals -for instance , American Diabetes Association ( ADA ) has recommended glycated hemoglobin ( HbA1c ) to be controlled below 7 % and stated that it should be maintained as close to normal level as possible in patients with short duration of T2DM , long life expectancy , and no cardiovascular disease [ 3,4 ] . Korean Diabetes Association ( KDA ) has recommended HbA1c below 6.5 % as target glycemic goal [ 5 ] . In general , a regimen of single oral hypoglycemic agent reduces HbA1c by approximately 1.5 % ; therefore , a combination therapy is recommended as initial management in HbA1c greater than 8 % [ 3 - 7 ] . The benefits of early combination therapy includes reduced glucotoxicity to β-cells through early normalization of blood glucose , reduced exposure time to hyperglycemia , and simultaneous blocking of multiple pathophysiology of T2DM [ 5,6 ] . The treatment guideline provided by ADA and European Association for the Study of Diabetes ( EASD ) , as well as that by KDA , recommends metformin in addition to lifestyle modification in patients with newly diagnosed T2DM as long as there are no contraindications [ 3 - 5 ] . In the past , addition of oral hypoglycemic agents with different mechanism of action or insulin was indicated after failure of metformin monotherapy ; however , since the recent recognition of importance of early aggressive glycemic control , metformin-based combination therapy has been widely employed in patients with HbA1c greater than 7.5 % to 8 % [ 3 - 6 ] . However , if combination of oral agents other than metformin is determined to be more effective based on several studies , an appropriate combination may be tailored to each patient depending not only on the mechanism , efficacy , side effect , and drug-drug interaction of each agent but also on individual lifestyle [ 3,6 ] . The major classes of hypoglycemic agents that may be combined with metformin include sulfonylurea ( SU ) , thiazolidinedion ( TZD ) , dipeptidyl-peptidase-4 inhibitor ( DPP4-i ) , insulin , and glucagon-like peptide-1 ( GLP-1 ) receptor agonist [ 6 ] . There is no clear guideline on the most effective combination regimen available for uncontrolled T2DM , and few studies investigated the effect of metformin-based early combination therapy . SU acts on β-cells of the pancreas as an insulin secretagogue-it is the most commonly used drug in conjunction with metformin [ 5,7 ] . One study evaluated the efficacy and safety of glyburide/metformin combination regimen as initial therapy in drug-naive T2DM patients over 2 years . The mean HbA1c at baseline and at 104 weeks after treatment was 8.4 % and 6.8 % , respectively . Combination with SU result ed in good glycemic control , but a significant increase in body weight and hypoglycemic episodes was noted [ 8 ] . While second generation SU ( e.g. , gliclazide , glimepiride ) report lower incidence of hypoglycemic episodes compared to long acting SU ( glyburide ) , it still needs to be taken into account in elderly patients [ 9 ] . In addition , another problem has been raised by a study entitled " A diabetes outcome progression trial (ADOPT)"-SU , when used as monotherapy agent , shows higher secondary failure rate compared to metformin or TZD [ 10 ] . Nonetheless , whether a similar result is observed when combined with metformin has not been reported as of yet . Pioglitazone , a peroxisomal proliferator-activated receptor γ agonist , reduces insulin resistance in the liver and peripheral tissues , leading to increases in suppression of hepatic glucose production and glucose uptake in peripheral tissues [ 6,7 ] . One cohort follow-up study compared and analyzed the results of initial combination therapy consisting of metformin and pioglitazone and initial sequential monotherapy of metformin and pioglitazone in T2DM patients with HbA1c greater than 7 % . This study found that initial combination therapy of metformin and pioglitazone was more effective than sequential combination therapy of metformin and pioglitazone in reaching and maintaining glycemic control , especially in subjects with HbA1c greater than 9 % [ 11 ] . Although pioglitazone  reduces the risk of death , myocardial infa rct ion , and stroke , there is potential weight gain , and its long-term use is associated with elevated risk of other side effects , such as bone fracture [ 12,13 ] . DPP4 inhibits DPP4 , an enzyme that de grade s incretin hormone GLP-1 , result ing in hypoglycemic effect [ 6,14 ] . Its combination with metformin is the subject of numerous recent studies . Lim et al. [ 15 ] reported a decrease in mean HbA1c of approximately 1.5 % in drug-naive Korean T2DM patients who initially underwent 52 weeks of combination therapy with metformin and stagliptin-this  efficacy was found to be greater in those with higher initial HbA1c after adjusting for BMI , insulin resistance , and other factors . In addition , it has suggested that DPP4-i may offer assistance in subjects with low β-cell function [ 15 ] . A series of recent studies have reported a combination regimen of metformin and DPP4-i to be associated with effective and safe glycemic control with no weight gain and low risk of hypoglycemia [ 16 - 18 ] . Nonetheless , there is a lack of studies on the effects of long-term DPP4-i use on cardiovascular disease , cancer , or the pancreas . The study by Lee et al. [ 19 ] was design ed to evaluate the efficacy of glycemic control in drug-naive or newly detected Korean T2DM patients receiving metformin-based dual combination therapy with SU , pioglitazone , or DPP4-i  , and they found similar hypoglycemic efficacy among SU , pioglitazone , and sitagliptin after 24 weeks of treatment in newly diagnosed T2DM subjects : this efficacy was similar or superior to that reported by other studies that combined SU , TZD , or DPP4-i to metformin [ 8,11,15 - 17 ] . Several studies have investigated which medications are more effective in Korean subjects [ 15,20,21 ] . In a study that reported more frequent  β-cell dysfunction  in Asian population compared to Westerners , combination therapy with SU could be effective in Korean [ 20 ] . DPP4-i was reported to be more effective in Asians than in Western [ 21 ] ; however , in another study that included diabetes in early stages , TZD demonstrated equal hypoglycemic efficacy when compared to SU [ 22 ] . These findings imply that it is difficult to label a specific drug as superior to others . Furthermore , patients with relatively high HbA1c at baseline responded well to combination oral hypoglycemic agent therapy [ 19 ] . Insulin therapy is the recommended treatment of choice in patients with HbA1c greater than 10 % to 11 % or with symptoms of hyperglycemia [ 3 - 6 ] ; however , in this study , dual therapy was initiated in subjects with HbA1c greater than 11 % . These patients showed a mean HbA1c below 6.5 % after 24 weeks of treatment , demonstrating that oral hypoglycemic agents can achieve adequate glycemic control within 24 weeks in early diabetic patients with severe hyperglycemia [ 19 ] . As the authors have stated , this maybe be due to relatively spared pancreatic β-cell function , as well as due to lower insulin resistance compared to study groups of other research es . The 2013 ADA/EASD guideline also recommended that glycemic target and control should be tailored to individuals [ 3 ] . In this study by Lee et al. [ 19 ] , metformin-based dual therapies with SU , TZD , and DPP4-i all showed similar efficacy . This suggests that the choice of oral hypoglycemic agents should be based on side effects , compliance , cost , and other factors rather than relying on a specific class of drug . Nonetheless , the analysis included only 24 weeks of data since the initial diagnosis , requiring further studies that evaluates not only the continued hypoglycemic efficacy of the combination therapy but also its side effects and its preventative effect on complications . A special attention should be paid in the future to the incidence of cardiovascular diseases and hypoglycemia in SU group , fracture and edema in TZD group , and pancreatitis , neoplasm , and cardiovascular disease in DPP4-i group Introduction : Type 2 diabetes mellitus ( T2DM ) is a major health issue in New Zeal and Māori . Clinical trials have demonstrated potential for the prevention of T2DM , but whether community public health programmes aim ing to prevent diabetes are effective is untested . Objective : To describe the planning and design of an intervention aim ing to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Māori community . Approach : Community concerns about the diabetes burden were heard by the local diabetes nurse , herself a tribal member , and discussed with a locally raised academic . Project planning ensued . The intervention and its evaluation were design ed using a participatory community development model . The planned intervention had three components : community-wide health promotion initiatives conveying healthy lifestyle messages , community education and monitoring for identified high-risk individuals and their extended families , and a structural strategy aim ed at adapting local environments to support lifestyle changes . The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a r and omised control trial design . Discussion : Consulting communities , validating community concerns and prioritising cultural and ethical issues were key steps . Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable , as the team were united in addressing the project planning and implementation challenges , such as funding obstacles that arose because of our ethically and culturally appropriate non-r and omised control trial evaluation design . The pre-intervention survey demonstrated high rates of diabetes ( 13 % ) , insulin resistance ( 33 % ) and risk factors , and provided evidence for positive , as opposed to negative , lifestyle intervention messages . Conclusion : Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities , but require a high level of commitment from the health sector and buy-in from the community . Adequate commitment , leadership , planning and re sources are essential Abstract .Practicing physicians as well as diabetes specialists are confronted with the often-frustrating experience of dealing with patients with poorly controlled diabetes . It is not always obvious why these patients fail to improve . The aims of this study were two-fold : ( a ) to determine if the interdisciplinary approach offered by the Western Negev  Mobile Clinic Diabetes Program ( WNMDCP ) is of benefit in patients with poorly controlled type 2 diabetes and ( b ) to more fully characterize patients refractory to treatment . Two primary -care clinics of the Western Negev were r and omly selected as control and intervention . All patients from both clinics with hemoglobin ( HbA1C ) ≥10 % ( tested during June-July 2000 ) were studied for 6 months . Patients from the control clinic continued the usual treatment . Patients from the intervention clinic received the interdisciplinary approach offered by WNMCDP . The rate of improvement of diabetes control , measured as a decrease in HbA1C values of at least 0.5 % , and compliance to treatment were determined . Overall , 48 of 258 patients in the intervention clinic and 34 of 179 patients in the control clinic met the inclusion criteria . At the 6-month follow-up , we observed significant improvements in plasma glucose ( -1.5 mmol/l ; p=0.003 ) and HbA1C ( -1.8 % ; p=0.00001 ) in the intervention group but not in the control group . The compliance and response rates were 85 % and 71 % for the intervention group and 32 % and 35 % for the control group , respectively . Patients from the intervention clinic showed significant improvement in the endpoints compared to patients from the control clinic . More than 70 % of patients with poorly controlled diabetes mellitus responded to the interdisciplinary treatment approach offered by WNMDCP . The group of non-responders comprised patients with poor compliance ( 15 % ) and those with serious concomitant diseases or limitations of mobility 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 Background Health education is considered to be essential in the overall care of patients with type 2 diabetes mellitus ( T2DM ) ;  systematic health education integrates individual education not only during hospitalization but also extended care outside of a hospital . To test effectiveness of the systematic health education model for T2DM , we conducted a r and omized study with a control group among patients with T2DM living in Nanjing , China . Methods 998 eligible patients completed the enrollment and were r and omized to systematic health education model and conventional model groups ( 498 and 500 patients , resp . ) . The systematic health education model was based on the following aspects : image education , visitation of the exhibition hall , dissemination of educational material s , individualized medical nutrition therapy and exercise programs , WeChat group and regular health lectures , evaluation of complications , lifestyle modification , systematic treatment scheme , self-monitoring of glycemic control , monthly evaluation of the therapeutic effect , proposed improvement measures , and individualized follow-up scheme . The main outcome measures were glycated hemoglobin A1c ( HbA1c ) , blood pressure , body mass index ( BMI ) , and lipids during the 2-year follow-up . Results The systematic health education model led to a favorable variation in HbA1c , LDL cholesterol , and systolic blood pressure ( SBP ) ( P < 0.05 ) . After adjusted analysis , the HbA1c decreased by 0.67 % ( P < 0.01 ) in the systematic health education model , SBP decreased by 10.83 mmHg ( P < 0.01 ) , and the level of diastolic blood pressure ( DBP ) , HDL cholesterol , and total cholesterol decreased slightly and was not significant . The BMI did not change significantly during the study in either of the two groups . Conclusions The systematic health education model is a useful method in the treatment of T2DM because it contributes to decrease in HbA1c , LDL cholesterol , and SBP levels , as well as helps in increasing the compliance with the control criteria , except for DBP and BMI OBJECTIVE To evaluate the impact of a multifaceted , school-based intervention on inner city youth at high risk for type 2 diabetes mellitus ( T2DM ) and to determine whether the addition of coping skills training ( CST ) and health coaching improves outcomes . METHOD 198 students in New Haven , CT at risk for T2DM ( BMI > 85th percentile and family history of diabetes ) were r and omized by school to an educational intervention with or without the addition of CST and health coaching .  Students were enrolled from 2004 to 2007 and followed for 12 months . RESULTS Students in both groups showed some improvement in anthropometric measures , lipids , and depressive symptoms over 12 months . BMI was not improved by the intervention . Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only . CONCLUSION A multifaceted , school-based intervention may hold promise for reducing metabolic risk in urban , minority youth Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 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 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 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
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .