Management trajectories in the type 2 XXXX Integrated Delivery System project in Taiwan: accounting for behavioral therapy, nutrition education and therapeutics.

@entity1 @entity4051 @entity8 @entity64 @entity6 @entity1674 @entity16 @entity4053 @entity1270 @entity989 @entity3918 @entity165
BACKGROUND AND AIM: Glycated hemoglobin (HbA1c) assessment is basic to @entity6 management. Little is done to describe the whole spectrum of the trajectory, its related temporal patterns of metabolic indices, and comorbidities. METHODS AND RESULTS: This was a longitudinal study. In the @entity6 Management through Integrated Delivery System project in Taiwan, enrollees had @entity6 , but no major comorbidities. They were randomized into intensive or conventional education (health, diet and exercise) groups. HbA1c was classified by a groupbased trajectory model on the basis of repeated six-monthly measurements. We analyzed data from 1091 subjects who had at least two measurements on HbA1c. HbA1c exhibited three distinct ranges of low (42-53 mmol/mol), intermediate (64-75 mmol/mol) and high (97 mmol/mol), all of which persisted for 4.5 years regardless of receiving intensive education or not. Temporal changes and a time-group interaction were found for @entity1674 , total @entity165 , HDL-C and LDL-C. The high trajectory was associated with the major co-morbidities of @entity989 , @entity8 , @entity16 , @entity64 , @entity4053 , and @entity1270 . @entity1 in the intensive education group (62.4%), which were equally distributed in the three trajectories, had significantly lower @entity4051 cs (-0.14%= -1.5 mmol/mol, p=0.026). The intermediate trajectory @entity1 with intensive education had @entity4051 cs higher than the low trajectory @entity1 with conventional education (b=0.189, p=0.033). Though not significant, a similar pattern was found for @entity3918 education in the high group (b=0.223, p=0.154). CONCLUSIONS: Novel strategies beyond current education and pharmacotherapeutic regimens are needed to lower HbA1c at least 11 mmol/mol for the high HbA1c group to minimize comorbidities.
