Study On The Preventive Effect Of DSMES Intervention In Elderly Patients With Newly Diagnosed Type 2 Diabetes Mellitus

Objective This study aims to explore the effect of diabetes self-management education and support(DSMES)intervention on elderly patients with newly diagnosed type 2 diabetes mellitus(T2DM),evaluate the effects of DSMES intervention and routine community education intervention on patients’blood glucose control,diabetes remission,liver function,kidney function,lipid metabolism,exercise habits and dietary structure changes.In order to provide evidence to support the optimization and implementation of comprehensive management and prevention strategies for community elderly patients with newly diagnosed T2DM in the northwest of China.Methods This study is a community intervention study.The subjects were elderly people at high risk for diabetes,and recruited from 22 community health service stations in Chengguan District,Lanzhou City,Gansu Province from December 2019 to December 2021.After the OGTT trial,elderly people aged 65 years and older,OGTT 2h blood glucose≥11.1mmol/L,BMI≥24.0Kg/m~2and function independent were included.And subjects with no intention to follow-up,activity disorder or previous T2DM were excluded.Subjects were community-based randomized into intervention and control groups on the principle of cluster randomized control.Community nurses were trained by the investigator,and all enrolled patients signed informed consent,completed the questionnaire,and established personal files.The intervention group was given DSMES intervention,while the control group was given routine community health education management.Clinical measurements such as blood glucose,blood lipid,liver function,renal function were monitored and recorded at baseline,6months and 12 months,and changes in diet and exercise were obtained by questionnaire.Data were analyzed by R software after the trial.Measurement data were expressed as mean±standard deviation or median(interquartile spacing).Frequency and percentage were used for the classified data.When compared the outcome indicators of the two groups after the intervention,theX~2test,T-test,Mann-Whitney test,or Fisher’s exact probability test was used.P<0.05 means the difference was statistically significant.Results This study is an interim report of 12 months out of a planned 36 months of national key projects.According to strict inclusion and exclusion criteria,a total of 338people were included,including 140 in the intervention group and 198 in the control group.Before the intervention,there were no statistically significant differences in general demographic data and clinical characteristics between the DSMES group and the control group(P>0.05).Baseline clinical data showed that in the intervention and control group,there were no statistically significant differences in the human measurement indicators(height,weight,BMI,hip circumference,blood pressure),liver function metabolism indicators(ALT,AST,total bilirubin),renal function metabolism indicators(serum creatinine,serum urea),blood lipid metabolism indicators(total cholesterol,serum triglyceride,LDL),blood glucose metabolism indicators(FPG,OGTT 2h PG),exercise habits(time and frequency of high,medium and low intensity exercise)and dietary structure(cereals,vegetables,fruits,legumes,dairy products,meat and eggs,confectionery).The two groups were comparable(P>0.05).After the intervention:1.Both DSMES and routine community health education intervention could reduce OGTT 2h PG of elderly newly diagnosed T2DM patients,with statistically significant difference(P<0.05).But had no significant effect on remission of diabetes mellitus(P>0.05).2.Compared with the control group,DSMES intervention could reduce BMI,systolic blood pressure and diastolic blood pressure(intervention for 6 months);improve renal function and lipid metabolism,and reduce serum urea and total cholesterol(intervention for 12 months),with statistically significant differences(P<0.05).3.DSMES intervention improved the time and frequency of moderate-intensity exercise(intervention for6 months)and low-intensity exercise such as walking(intervention for 12)in elderly patients with new-onset T2DM,and the difference was statistically significant(P<0.05).4.DSMES intervention improved the average daily intake and equivalent energy of dairy products,meat and eggs in elderly patients with newly diagnosed T2DM,and the difference was statistically significant(P<0.05).Conclusion DSMES intervention has a positive effect on reducing the risk factors of cardiovascular and cerebrovascular diseases in elderly overweight patients with newly diagnosed T2DM in the community,reducing BMI and blood pressure,helping patients reduce postprandial blood glucose level and improve renal function and lipid metabolism indicators.DSMES can improve self-management behavior in elderly patients with newly diagnosed T2DM in terms of diet and exercise habits.Specifically,it increased the duration and frequency of moderate and light intensity physical activity and increased consumption of dairy products,meat and eggs in the target population.