Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report
Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed. This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutive...
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| Veröffentlicht in: | PloS one 2019-12, Vol.14 (12), p.e0226132-e0226132 |
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| creator | Haslacher, Helmuth Fallmann, Hannelore Waldhäusl, Claudia Hartmann, Edith Wagner, Oswald F Waldhäusl, Werner |
| description | Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed.
This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d.
At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization ( |
| doi_str_mv | 10.1371/journal.pone.0226132 |
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This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d.
At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital.
Our observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. To this end, 'imprinting' patients at a DRC could be of considerable help.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0226132</identifier><identifier>PMID: 31830073</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Analogs ; Analysis ; Anticholesteremic agents ; Antidiabetics ; Antilipemic agents ; Biology and life sciences ; Care and treatment ; Clinical outcomes ; Delivery of Health Care - organization & administration ; Delivery of Health Care - standards ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - rehabilitation ; Diabetes Mellitus, Type 2 - therapy ; Family medical history ; Female ; Gastrointestinal surgery ; Glucose ; Hemoglobin ; High density lipoprotein ; Hospitals, Rehabilitation - organization & administration ; Hospitals, Rehabilitation - standards ; Humans ; Hypoglycemic agents ; Hypoglycemic Agents - therapeutic use ; Immunization ; Imprinting ; Influenza ; Insulin ; Intervention ; Laboratories ; Lifestyles ; Lipid metabolism ; Lipids ; Low density lipoprotein ; Male ; Meals ; Medicine and Health Sciences ; Metabolic disorders ; Metabolism ; Metformin ; Middle Aged ; Obesity ; Patient compliance ; Patient education ; Patients ; Prevalence studies (Epidemiology) ; Quality Improvement - standards ; Rehabilitation ; Standard of Care - standards ; Standardization ; Treatment Outcome ; Type 2 diabetes ; Variables ; Weight control ; Young Adult</subject><ispartof>PloS one, 2019-12, Vol.14 (12), p.e0226132-e0226132</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Haslacher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Haslacher et al 2019 Haslacher et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-57e07c8db02c379b3ef11ec43a1f676de8b904e8f677f0944c750a33c603aae93</citedby><cites>FETCH-LOGICAL-c692t-57e07c8db02c379b3ef11ec43a1f676de8b904e8f677f0944c750a33c603aae93</cites><orcidid>0000-0003-4605-2503 ; 0000-0003-4024-1709</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907777/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907777/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31830073$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bryner, Randy Wayne</contributor><creatorcontrib>Haslacher, Helmuth</creatorcontrib><creatorcontrib>Fallmann, Hannelore</creatorcontrib><creatorcontrib>Waldhäusl, Claudia</creatorcontrib><creatorcontrib>Hartmann, Edith</creatorcontrib><creatorcontrib>Wagner, Oswald F</creatorcontrib><creatorcontrib>Waldhäusl, Werner</creatorcontrib><title>Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed.
This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d.
At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital.
Our observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. 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organization & administration</subject><subject>Hospitals, Rehabilitation - standards</subject><subject>Humans</subject><subject>Hypoglycemic agents</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Immunization</subject><subject>Imprinting</subject><subject>Influenza</subject><subject>Insulin</subject><subject>Intervention</subject><subject>Laboratories</subject><subject>Lifestyles</subject><subject>Lipid metabolism</subject><subject>Lipids</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Meals</subject><subject>Medicine and Health Sciences</subject><subject>Metabolic disorders</subject><subject>Metabolism</subject><subject>Metformin</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Patient compliance</subject><subject>Patient education</subject><subject>Patients</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Quality Improvement - standards</subject><subject>Rehabilitation</subject><subject>Standard of Care - 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An observational report</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-12-12</date><risdate>2019</risdate><volume>14</volume><issue>12</issue><spage>e0226132</spage><epage>e0226132</epage><pages>e0226132-e0226132</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed.
This pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d.
At admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital.
Our observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. To this end, 'imprinting' patients at a DRC could be of considerable help.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31830073</pmid><doi>10.1371/journal.pone.0226132</doi><tpages>e0226132</tpages><orcidid>https://orcid.org/0000-0003-4605-2503</orcidid><orcidid>https://orcid.org/0000-0003-4024-1709</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2325295566 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Analogs Analysis Anticholesteremic agents Antidiabetics Antilipemic agents Biology and life sciences Care and treatment Clinical outcomes Delivery of Health Care - organization & administration Delivery of Health Care - standards Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - rehabilitation Diabetes Mellitus, Type 2 - therapy Family medical history Female Gastrointestinal surgery Glucose Hemoglobin High density lipoprotein Hospitals, Rehabilitation - organization & administration Hospitals, Rehabilitation - standards Humans Hypoglycemic agents Hypoglycemic Agents - therapeutic use Immunization Imprinting Influenza Insulin Intervention Laboratories Lifestyles Lipid metabolism Lipids Low density lipoprotein Male Meals Medicine and Health Sciences Metabolic disorders Metabolism Metformin Middle Aged Obesity Patient compliance Patient education Patients Prevalence studies (Epidemiology) Quality Improvement - standards Rehabilitation Standard of Care - standards Standardization Treatment Outcome Type 2 diabetes Variables Weight control Young Adult |
| title | Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T04%3A46%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Type%202%20diabetes%20care:%20Improvement%20by%20standardization%20at%20a%20diabetes%20rehabilitation%20clinic.%20An%20observational%20report&rft.jtitle=PloS%20one&rft.au=Haslacher,%20Helmuth&rft.date=2019-12-12&rft.volume=14&rft.issue=12&rft.spage=e0226132&rft.epage=e0226132&rft.pages=e0226132-e0226132&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0226132&rft_dat=%3Cgale_plos_%3EA608456618%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2325295566&rft_id=info:pmid/31830073&rft_galeid=A608456618&rft_doaj_id=oai_doaj_org_article_839bdbe594af4a32b934cda1afbd4bba&rfr_iscdi=true |