| Objective:Our study targeted people were type 2 diabetes(Type 2 Diabetes Mellitus,T2DM)with overweight or obese patients who received comprehensive diabetes intervention(clinical drug therapy combined with lifestyle intervention)in 47 hospitals in Tianjin to explore the effect of short-term comprehensive intervention on blood glucose control in this population.On this basis,the influencing factors of the effect of comprehensive intervention were explored,which provided a reference for further improving the compliance rate of Hb A1c(Glycosylated Hemoglobin,Hb A1c).Finally,the Markov model was used to evaluate the cost-effectiveness of the short-term comprehensive intervention project,and the feasibility and extrapolation of the project are discussed from an economic perspective,which provides a scientific basis for the blood glucose management and long-term resource optimization of patients with type2 diabetes in China.Methods:1.This study adopted statistical descriptions of different indicators(General situation,living habits,clinical indicators and biochemical indicators)before and after short-term comprehensive intervention in 1 356 T2DM patients with overweight or obesity who have completed 6 months of comprehensive intervention in the database of the"2018 Tianjin City Change Diabetes"project,to analyze the effects of short-term comprehensive interventions.2.According to the level of Hb A1c after 6 months of intervention,the intervention effect was divided into intervention effective group(Hb A1c<7%)and intervention ineffective group(Hb A1c≥7%).At the same time,a multiple logistic regression model was constructed using it as the dependent variable,to analyze the influencing factors of short-term comprehensive intervention effect.3.Constructing Markov model to compare comprehensive intervention with conventional clinical treatment.After a five-year simulation cycle,the cost inputs and benefits obtained between the overall situation of the two groups,different genders and different age groups(<45 years old,45-60 years old,≥60 years old)are compared,and the economic feasibility of short-term comprehensive intervention is explored.Results:1.Effect of short-term comprehensive intervention:(1)A total of 1 356patients were included in this study,including 832(61.36%)males.The median age of the study participants was 53.5(42.0,60.0)years old,and the median body weight was86.0(78.0,96.0)kg.Body Mass Index(BMI)was 30.71(28.2,34.3)kg/m2,median waist circumference was 101.0(94.0,110.0)cm,centrally obese patients were 447(32.96%),and median duration of diabetes 8.0(4.0,13.0)years;1 070(78.91%)patients who smoked,451(33.26%)patients who consumed alcohol,and 1 242(91.59%)patients who liked meat,there were 1 056(77.88%)patients with home oil as the main oil,and 876(64.60%)patients who participated in physical exercise(physical exercise time≥150 min/week).Median fasting blood glucose(FPG),median 2 h postprandial blood glucose(2h PG),and the median glycated hemoglobin(Hb A1c)was 8.7(7.6,10.0)mmol/L,11.9(10.3,13.9)mmol/L,and 8.4(7.6,9.6)%;the glycated hemoglobin of 1 356 patients did not meet the standard,and the compliance rate was 0%;(2)After 6 months of intervention,the clinical indicators of the patients were significantly reduced,such as body mass,BMI,waist circumference,and central obesity.The differences in the clinical indicators before and after the intervention were statistically significant(P<0.05).After 6 months of intervention,the median body weight of the patient was 83.0(74.0,92.0)kg,the median BMI was 29.4(27.0,32.7)kg/m~2,the waist circumference was 98.0(89.0,105.5)cm,and the number of central obese patients was 384(28.32%)cases;after 6 months of intervention,the patients’living habits were significantly improved,and the difference before and after the intervention was statistically significant(P<0.05).After 6 months of intervention,the number of alcohol drinkers decreased to 374(27.58%)For example,eating habits increased from 8.41%of vegetarians to 19.03%,the number of patients with vegetable oil as the mainstay gradually decreased to 899(66.30%),and the number of physical exercises reached 926(68.29%);the levels of various biochemical indicators(FPG、2h PG and Hb A1c)were significantly lower than before the intervention,and were reduced to 7.0(6.3,7.8)mmol/L,9.1(8.4,10.5)mmol/L and 6.7(6.3,7.1)%;the compliance rate of glycated hemoglobin increased from 0%to 72.94%,and the number of people who met the standard reached 989.2.Factors influencing of short-term comprehensive intervention effects:After adjusting for baseline Hb A1c levels,the results suggest that the course of disease is a risk factor for short-term comprehensive intervention effects,high income(≥3,000 yuan/month),and improvement in household oil use(to Animal oil-based to vegetable oil-based)as a protective factor for short-term comprehensive intervention.3.Health economic evaluation of short-term comprehensive intervention:(1)Compared with the conventional clinical treatment group,the comprehensive intervention group can save an additional 0.024 QALYs while saving 3,495.19 yuan,and its incremental cost-effectiveness ratio(ICER)is-144,935.78 yuan/QALYs,far less than the willingness to pay(356,832 yuan);(2)Compared with the conventional clinical treatment group,both men and women in the comprehensive intervention group have higher economic benefits.The male group can reduce investment by 259.59(59,004.85 vs 59,264.44)yuan,but can receive an additional 0.008(4.414 vs 4.406).For the benefits of QALYs,the female group can reduce investment by 11,201.52(55,570.3 vs 44,368.78)yuan,and get 0.059(4.401 vs4.460)more QALYs.At the same time,compared with the conventional clinical treatment group,the ICER of the male group is-32,823.73 yuan/QALYs,The ICER of the female group is-192,733.96 yuan/QALYs,which is much lower than that of the male group;(3)Compared with the conventional clinical treatment group,after receiving comprehensive intervention,people with different age groups received less than 0 ICERs(<45 year old age group:-229,386.33 yuan/QALYs,45～60 year age group:-188,967.74 for the yuan/QALYs,≥60 years old age group:-43,377.80 yuan/QALYs),and patients in the lower age group save the most cost,which is 1229,386.33yuan.Conclusion:1.The short-term comprehensive intervention has shown good clinical effects,which can effectively reduce the body mass index and various blood glucose indexes of T2DM with overweight or obese patients,improve the lifestyle of patients,and increase the rate of Hb A1c compliance.2.Multivariate analysis results showed that after correction of baseline Hb A1c levels,the improvement of disease duration,per capita monthly income,and household oil use(conversion from animal oil to vegetable oil)was effective in comprehensive intervention(Hb A1c<7%).The influencing factors suggest that attention should be paid to low-income groups,and early intervention and early control should be implemented for T2DM patients who have been diagnosed for the first time.At the same time,dietary intervention should be emphasized in comprehensive interventions to enhance the importance of T2DM patients on their health management and increase T2DM Patient compliance to better control Hb A1c and reduce the incidence of T2DM complications.3.The results of health economic evaluation show that if 3 times the GDP per capita of Tianjin is the maximum willing to pay,the short-term comprehensive intervention project for T2DM with overweight and obese patients has economic value.Especially in the lower age group(<45 years old)and female patients,it shows better economic application value. |
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