Abstract
BackgroundOutcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed.Aims and methodsThis 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.ResultsAt 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.ConclusionsOur 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.
Highlights
Type 2 diabetes is a major health burden
Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p
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
Summary
Type 2 diabetes is a major health burden. Its prevalence increases worldwide [1] based on a polygenic background [2] due to environmental and behavioral risk factors [3] causing energy imbalance, diabesity, and insulin insensitivity [4].Treatment of type 2 diabetes requires a multifactorial integrated treatment regimen [5] including permanent self-control of energy balance, i.e., of daily food intake and exercise load. To meet metabolic goals set [6], and to avoid the development of microvascular [7] as well as macrovascular complications [8], patients with type 2 diabetes have to provide comprehensive self-care aiming at control of blood glucose, serum lipid concentrations and blood pressure (BP). Together, these efforts may either induce remission to a non-diabetic state off antidiabetic drugs [9], or test the patients’ motivation to comply with treatment recommendations. Outcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed
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