Application Of A Comprehensive Dsms In Diabetes Patients Using Insulin

Background and AimIt is known that China has the largest population of diabetic patients.The incidence of diabetes is increasing year by year.Glycated Hemoglobin(Hb A1c)is the standard of blood glucose control.Fasting Blood Glucose(FBG)is also a marker for screening diabetes patients.Research suggests that the standard of glucose metabolism is generally low in China.Diabetes Self-Management Support(DSMS)is necessary for diabetes patients using insulin,and this support can effectively improve their health outcomes.However,the level of DSMS in China is generally low.On that basis,This study investigated the characteristics of diabetes patients using insulin in mainland China.The effectiveness of comprehensive DSMS on blood glucose control in diabetes patients using insulin was evaluated by “E”nsulin Peer Support Project database.Moreover,we analysed the influencing factors among diabetes patients using insulin in relation to the standard of glucose metabolism.The findings will provide guidance for clinical practice.MethodsThis multicentre,retrospective,real-world study was based on the “E”nsulin Peer Support Project.General data,the results of physical examination and laboratory examination were collected for diabetes patients who used insulin from 452 hospitals across China(N=32,390).The comprehensive DSMS comprised medical support,peer support and information technology support,which formed a combined mode of the DSMS.Glycated haemoglobin(Hb A1c)<7% was considered the standard for Hb A1 c control.We analysed the factors influencing successful Hb A1 c control using single factor analysis,based on a logistic regression model.Paired t test and Pearson chi square test were used for comparison within groups.Regression analysis was used to explore the correlation: logistic regression was used for binary variables.Data analysis was performed using SPSS 23.0 and R Programming Language.The differences were considered statistically significant at P<0.05.Results1.Analysis of patients’ basic information revealed that the average Hb A1 c level was 8.18%±2.12%,and the Hb A1 c compliance rate was 25.7%.The Hb A1 c compliance rate in Middle China was the highest at 28.8%,and that in South China was the lowest at 18.2%.The average FBG level was(7.71±2.34),and the FBG compliance rate was 40.1%.The average frequency of hyperglycemia was(8.21±18.44),and the average frequency of hypoglycemia was(0.40±3.34).The Hb A1 c compliance rate of patients with combination therapy was 21.5%.The Hb A1 c compliance rate of patients using insulin alone was 26.7%.2.T test was used to analyze the glucose metabolism before and after comprehensive DSMS intervention.There were statistically significant differences in results(P < 0.05).3.Before the comprehensive DSMS intervention,there were statistically significant differences in age,gender and BMI between the Hb A1 c compliant group and the non-compliant group(P < 0.05).In addition,there were influenced between age,gender and Hb A1 c compliance rate.After 6 months of the comprehensive DSMS intervention,the average Hb A1 c level decreased to 7.42%±1.55%,and the compliance rate increased to 40.9%.The average FBG level was decreased to 6.94±1.50,and the compliance rate increased to 56.1%.There were statistically significant differences in age,duration of disease and acceptance of DSMS between the Hb A1 c compliant group and the non-compliant group(P < 0.05).In addition,there were influenced between age,gender,DSMS frequency and Hb A1 c compliance rate.Conclusion1.In China,the glucose metabolism compliance rate for diabetes patients using insulin is low,and there are regional differences.DSMS has various forms but its level is not high.Therefore,more attention and intervention are needed.2.The comprehensive DSMS is effective in improving outcomes for diabetes mellitus.In clinical practice,the comprehensive application of DSMS should be advocated,suggesting that clinical management for these groups should be strengthened.It provides the basis for constructing a maturity DSMS system.3.Men and older patients are more likely to fail to control blood sugar.The more times of comprehensive DSMS,the easier Hb A1 c reach the standard.In clinical practice,combining the characteristics of different populations to improve the outcomes for diabetes patients.