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Objective:To evaluate the relationship between hemoglobin(Hb) level and the risk of diabetic retinopathy(DR) in patients with type 2 diabetes mellitus(T2DM).Methods:This study was a prospective cohort study. A total of 1 730 T2DM patients without DR, who received regular management at the Li′s Clinic in Taiwan, China starting from 2002, were selected as the study population. All patients underwent annual dilated fundus examination by professional ophthalmologists. General patient information and laboratory results were collected and analyzed. Based on the occurrence of DR during patient follow-up, patients were divided into the DR group and the non-DR(NDR) group. The impact of Hb levels on DR was explored using a generalized linear mixed model, and the relationship between Hb levels and DR was studied using Cox proportional hazards regression model.Results:After an average follow-up of 9.79 years, 481 patients with DR were detected. Compared with NDR group, DR group displayed a longer course of diabetes, higher rates of cataract, insulin use, and anemia, and higher systolic blood pressure, HbA 1C, and UACR as well as lower Hb. The results of the generalized linear mixed model showed a negative correlation between Hb and the occurrence of DR( β=-0.015, P<0.001). The Cox proportional hazards regression model showed that, after adjusting for confounding variables and based on quartiles of average Hb levels during follow-up, the risk of developing DR increased by 56.9% in the Q1 group(Hb≤127 g/L) compared to the Q4 group(Hb≥142 g/L). The cumulative risk plot showed that, after adjusting for confounding variables, the Q1 group had the highest cumulative risk of developing DR, and the difference was statistically significant( P<0.05). Conclusion:Hb was negatively correlated with DR, and the lower Hb levels were associated with the occurrence of DR, independent of other influencing factors.
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Objective:To evaluate the effect of urinary albumin creatinine ratio (UACR) on diabetic retinopathy (DR) in patients with type 2 diabetes. Receiver operating characteristic (ROC) curve was applied to find the cut-off value of UACR for diagnosing DR.Methods:A prospective cohort study of 2 490 patients with type 2 diabetes was conducted with a mean follow-up of 7 years ranging from 3 to 10 years. Dilated fundus examination was performed once a year, and patient history and clinical data were collected and analyzed. Patients were divided into three groups according to the UACR: Q1, normal urinary albumin group (UACR<30 mg/g), Q2, microalbuminuria group (30 mg/g≤UACR≤299 mg/g), and Q3, macroalbuminuria group (UACR>300 mg/g), respectively. Cox regression analysis was used to explore the influence of UACR and other factors on DR, and ROC curve was drawn to evaluate the value of UACR in diagnosis of DR.Results:Cox regression analysis showed that UACR was the risk factor of DR( HR=1.108, 95% CI 1.023-1.241, P<0.001). It showed that the patients in Q3 group had the highest risk of proliferative DR ( HR=3.128, 95% CI 2.025-4.831, P<0.001), the patients in Q2 group followed( HR=1.918, 95% CI 1.355-2.714, P<0.001), and the patients in Q1 group were the lowest. ROC curve analysis showed that area under UACR curve was 0.746(95% CI 0.681-0.812, P<0.001), and the cut-off value, sensitivity, and specificity for the diagnosis of PDR were 54.12mg/g, 0.769, and 0.653, respectively. Conclusion:The UACR can predict the progression of PDR in type 2 diabetes patients, therefore it may be used as a preliminary predictor for the progression of DR.
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Objective:To analyze the association between HbA 1C variability and the incidence of diabetes retinopathy in patients with type 2 diabetes mellitus(T2DM). Methods:All the patients with type 2 diabetes receiving regular follow-up were enrolled from Lee′s Joint Clinic from 2002 to 2014. Demographic and laboratory data like HbA 1C were collected including fundal examination. According to HbA 1C variability, which was defined as the difference between baseline and last available HbA 1C, participants were divided into three groups, stable group with HbA 1C variability of ±10%, increase group(>10%), and decline group(<-10%). Results:A total of 3 657 T2DM participants were recruited including 662(13.4%) participants with diabetes retinopathy. Blood glucose gradually rose from ideal level [HbA 1C(7.04±1.35)%] and HbA 1C was up to (9.11±1.96)% at the end of follow-up in increase group. HbA 1C gradually fell to (7.27±1.12)% from (10.05±1.99)% of baseline in decline group. HbA 1C of the third group remained relatively stable. Adjusted for age, body mass index, systolic blood pressure, pulse pressure, duration of diabetes, mean HbA 1C of follow-up, glaucoma and so on, logistic regression revealed that participants in stable group( OR=0.800, 95% CI 0.645-0.992) and increase group( OR=0.706, 95% CI 0.548-0.909) had a lower risk of diabetes retinopathy than decline group( P<0.05). Conclusion:HbA 1C variability is an important risk factor of diabetes retinopathy in patients with T2DM. Patients with blood glucose declined had increased risk of diabetes retinopathy as compared to those with rising HbA 1C.
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Objective:To evaluate the impacts of resistance training(RT)and aerobic training(AT)for 24 months on the risk of type 2 diabetes in patients with pre-diabetes.Methods:Two hundred forty-eight pre-diabetic patients were enrolled in this multi-center randomized controlled trial. All patients were randomly divided into 3 groups: RT( n=82), AT( n=83), and control( n=83)groups. The participants in RT and AT groups undertook moderate RT or AT 3 times a week(150 minutes/week)under supervision in 3 research centers for 24 months. Elastic bands were used in each session of RT, with intensity of 60% 1RM(maximum weight that muscle can lift at once). Patients in AT group performed aerobic dance at 60%-70% of maximum heart rate. Assessments for each subject were made at baseline and by the end of 6, 12 and 24 months. Primary outcomes were changes in the risk of type 2 diabetes. Secondary outcomes included changes in blood glucose, blood lipids, and blood pressure. Results:There were 217, 206, and 173 subjects who completed the follow-up of 6, 12, and 24 months, respectively. The mean ages of RT, AT, and control groups at baseline were(59.91±5.92), (60.93±5.71), and(60.73±5.83)years. Compared to control group, both RT and AT groups revealed a significant reduction in HbA 1C( P<0.05), and a significant increase in homeostasis model assessment for β-cell function index(HOMA2-β, P<0.01)by the end of 12 and 24 months. Adjusted for age, gender, statin use, lipid profile, blood pressure, and body mass index, COX regression analysis showed that RT and AT reduced the risk of type 2 diabetes by 55.6%( P=0.012)and 59.8%( P=0.010). Conclusions:This study demonstrates that 24-month moderate RT and AT have comparable effects on reducing insulin resistance, improving β-cell function, blood glucose and lipid, and reducing the risk of type 2 diabetes.
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Objective:To analyze the effects of different blood pressure variables and their variabilities on diabetic nephropathy(DN)in patients with type 2 diabetes.Methods:This prospective cohort study included 3 050 type 2 diabetic patients without DN at baseline from Lee′s clinic in Taiwan, China. The metabolic parameters of patients were regularly checked, and urine albumin creatinine ratio(UACR)were evaluated annually. The average follow-up period was 7 years(3-10 years). The means and standard deviations(SD)of systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP), and mean arterial pressure(MAP)were calculated. According to whether SBP-Mean was higher or lower than 130 mmHg(1 mmHg=0.133 kPa) and SBP-SD was higher or lower than 11.06 mmHg(average SBP-SD), these patients were divided into four groups: Q1(SBP-Mean<130 mmHg, SBP-SD<11.06 mmHg); Q2(SBP-Mean<130 mmHg, SBP-SD≥11.06 mmHg); Q3(SBP-Mean≥130 mmHg, SBP-SD<11.06 mmHg); Q4(SBP-Mean≥130 mmHg, SBP-SD≥11.06 mmHg). In the same way, according to whether PP-Mean was higher or lower than 80 mmHg(average PP-Mean)and PP-SD was higher or lower than 6.48 mmHg(average PP-SD), the patients were divided into Q1-Q4 groups.Results:After adjusting age, sex, and diabetes duration, Cox regression analysis showed that SBP-Mean, SBP-SD, PP-Mean, and PP-SD were the risk factors of DN. After the stratification according to SBP-Mean and SBP-SD, the patients in Q4 group( HR=1.976, P<0.001)had the highest risk while those in Q1 group displayed the lowest risk for DN. Additionally, the patients in Q3 group( HR=1.614, P<0.001)imposed a higher risk than that in Q2 group( HR=1.408, P<0.001). By stratificating the patients based on PP-Mean and PP-SD, the patients in Q4 group revealed the highest risk of DN( HR=1.370, P<0.001)while those in Q1 group had the lowest risk. In addition, the patients in Q3 group( HR=1.266, P<0.001)had a higher risk of DN compared with those in Q2 group( HR=1.212, P<0.001). Conclusion:SBP and PP variabilities are the predictors of DN in patients with type 2 diabetes.
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Objective:To investigate the effect of a 2-year resistance and aerobic training on reducing the risk of cardiovascular disease in patients with prediabetes.Methods:A total of 248 patients with prediabetes were enrolled from Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January to April 2014, and Danyang People′s Hospital and The First Affiliated Hospital of Guangxi Medical University from May to December 2014.Based on random number table method, the patients were divided into 3 groups: the resistance training group (RT group, 82 cases), the aerobic training group (AT group, 83 cases) and control group (83 cases). Participants in the RT group and the AT group underwent a total of 24 months of exercise training. Changes in indicators (blood glucose,blood lipid, etc.) at baseline and the end of 12 and 24 months among the groups were compared.Results:After intervention, glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL-C), blood pressure and homeostasis model 2 insulin resistance index (HOMA2-IR) in the RT and AT groups tended to decrease, and the steady state model 2 β cell function index (HOMA2-β) tended to increase. At the end of 24 months, HbA1c [5.80 (5.43, 6.20) %, 5.70 (5.50, 6.00)% vs. 6.20 (5.70, 6.60) %, all P≤ 0.01], LDL-C [3.07 (2.69, 3.58) mmol/L, 2.97 (2.62, 3.95) mmol/L vs. 3.21(2.54, 3.78) mmol/L, all P<0.05] and HOMA2-IR [0.96 (0.82, 1.47), 1.20 (0.99, 1.43) vs. 1.34 (1.09, 1.51), all P<0.05] were significantly decreased in the RT and AT groups than in the control group. In addition, HOMA2-β [84.50 (60.55, 107.33), 93.00 (78.60, 119.75) vs. 53.40 (37.70, 80.40), all P = 0.001] was significantly increased in the AT and RT groups compared with that in the control group. There were no significant differences in triglyceride (TG) and high-density lipoproteincholesterol (HDL-C) levels between the training groups and the control group (all P>0.05). After adjusting for age, sex and blood pressure, the cardiovascular risk of prediabetes was significantly reduced in RT ( P =0.017) and AT groups ( P =0.018). The Cox regression analyses showed that both the resistance training (HR=0.419, 95 %CI =0.415-0.942, P=0.037) and the aerobic training ( HR=0.310, 95 %CI=0.447-0.866, P=0.026) were protective factors for cardiovascular disease in prediabetic patients after adjustment of age, sex, statins, body mass index and waist-to-hip ratio, which reduced the risks of cardiovascular disease in prediabetic patients by 58.1% and 69.0%, respectively. Conclusions:Two years of aerobic and resistance training interventions have obvious advantages on glycemic and insulin resistance control in prediabetes patients. The resistance training can reduce the risk of cardiovascular disease, and it is, thus, recommended for prediabetic patients without obvious exercise contraindications.
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Objective:To investigate the relationship between HbA 1C variability and diabetic retinopathy(DR) in patients with type 2 diabetes and to explore the influencing factors of HbA 1C variability. Methods:Type 2 diabetic patients who received dilated funduscopic examination annually, were stratified into two groups based on the presence or absence of DR, with a median follow-up period of 4 years(2-5 years). Intrapersonal means and SDs of all recorded HbA 1C measurements were calculated. A 1C-SD represented the measure of HbA 1C variability. In addition, medical history and clinical data of all subjects were collected and analyzed. Subjects were divided into four quartiles based on their A 1C-Mean and A 1C-SD data: Q1(A 1C-Mean<7%, A 1C-SD<0.76%); Q2(A 1C-Mean<7%, A 1C-SD≥0.76%); Q3(A 1C-Mean≥7%, A 1C-SD<0.76%); Q4(A 1C-Mean≥7%, A 1C-SD≥0.76%). Results:Multivariate linear regression showed that exercise, insulin( P<0.01), and smoking( P=0.004) are the influencing factors of HbA 1C variability. Adjusted for age, sex, and diabetes duration, Cox regression analysis revealed that HbA 1C variability was an independent risk factor for DR. Meanwhile, patients in Q4 group had the highest DR prevalence(HR=1.676, P<0.01) while Q1 group had the lowest. In addition, patients in Q2 group(HR=1.437, P=0.005) had a higher risk of DR than those in Q3 group(HR=1.361, P<0.01). Conclusions:HbA 1C variability is an independent predictor of DR in patients with type 2 diabetes. It may play a greater role in DR development than mean HbA 1C does when the mean value of HbA 1C variability index is above 0.75%.
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Objective To assess the effectiveness of a novel mobile health patient management system involving doctors, nurses, and patients ( TRIO mode) on glycemic control and self-monitoring of blood glucose (SMBG) compliance among the type 2 diabetes mellitus ( T2DM) patients using basal insulin standardization treatment in China. Methods From April 2014 to April 2015, 416 hospitals in 110 cities of 30 provinces, municipalities, and autonomous regions across China were selected to participate in the program. A Online-to-Offline ( O2O) integrated mobile health patients management system with mobile terminals for the doctors, nurses, and patients was applied in the program for patient education, follow-up, and data collection. For all the newly recruited patients, the baseline information was collected and a first-day patient education program were provided by a designated nurse. In the 12-week follow-up period, data of basal insulin doses and fasting plasma glucose ( FPG) values were collected from the patients by text messages or tracking phone call by the nurse. The patients also received timely standardized patients health education and glycemic control guidance by participating in thepatient education forum anddoctors' hotline in order to help them achieve the glycemic control goals. Results A total of 102 524 patients using basal insulin treatment were eligible and enrolled in the program. 64 420 patients completed the 12 weeks follow-up and provided at least one FPG value at all five follow-ups. In total, 62. 6% (40 334 / 64 420) of the patients reached the FPG control target(FPG≤7. 0 mmol/ L) at the end of follow-up period. The weekly average FPG for patients with complete SMBG data decreased from 10. 58 mmol/ L to 6. 91 mmol/ L while the FPG control rates increased from 13. 4% to 69. 2% . The weekly average FPG for the patients provided incomplete SMBG data decreased from 10. 54 mmol/ L to 7. 13 mmol/ L while the FPG control rates increased from 13. 6% to 62. 2% . The FPG control rates for the patients provided complete SMBG were 1. 74 times higher than those patients provided incomplete SMBG. Based on a GEE model, the average decline of the FPG and the increase of the FPG control rates were significantly better for patients who provided complete SMBG as compared to the patients with incomplete SMBG data. The results of the multivariate logistic regression analysis showed that factors such as receiving the first-day education, participating in the follow-up patient education forum, and the doctors' hotline were significantly associated with the improvement of the SMBG compliance, the treatment adherence, and the FPG control rates. The SMBG compliance and the treatment adherence for patients who completed first-day education were 1. 68 times and 1. 22 times higher, respectively. For the patients who participated in follow-up education activities, their SMBG compliance and treatment adherence were 3. 17 times and 3. 36 times higher, respectively. Conclusion The innovativeTRIOmobile health patient management mode was feasible and effective for better managing the type 2 diabetes patients initiated on basal insulin treatment in China. Active participation in the first-day education program and the follow-up patient education activities can effectively improve the SMBG compliance and the treatment adherence, and therefore play an important role in helping patient achieving FPG control in a faster manner.
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Objective To observe the sleeping time and analyze its impact on the psychological state and quality of life of patients with type 2 diabetes .Methods Convenience sampling was used to recruit 365 patients with type 2 diabetes in Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Chinese Medicine between April 2014 and April 2015 .All the patients were divided into two groups according to the six-hour cut-off point of sleeping time .They were investigated by means of World Health Organization Quality of Life-BREF ( WHOQOL-BREF), Diabetes Distress Scale ( DDS) and General Self-Efficacy Scale ( GSES).Data were analyzed by t-test, chi-square test, Mann-Whitney U test and multivariate regression analysis .Results The average sleeping time was 7.03 h, and the sleeping time of 109 patients was less than 6 h.Patients with less sleeping time had lower quality of life and self-efficacy scores as well as higher diabetes distress scores than those with sleeping time more than 6 h.The differences were statistically significant (P<0.05).Regression analysis showed that sleeping time was the factor of quality of life (β=0.117, P=0.047), self-efficacy (β=0.136, P=0.024) and diabetes distress(β=-0.118, P=0.046).Conclusion Sleeping time affects the psychological state and quality of life of patients with type 2 diabetes.The medical should pay more attention to the quality of sleep of such patients .
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Objective To evaluate the effect of resistance training on glucolipid metabolism in a population with pre-diabetic metabolism (PDM).Methods Sixty persons with PDM were randomly divided into a resistance training group,an aerobic training group and a control group,each of 20 members.The exercise intervention groups exercised 3 times a week for 12 weeks in accordance with the exercise prescription,while the control group was without any regular aerobic exercise or resistance training.Before and after the 3 months of exercise training,fasting blood glucose (FBG),2 hours postpradial blood glucose (PBG),HbAlc,and lipid profile were tested.Body mass index (BMI),waistline,and blood pressure were also measured.Results Before the intervention,there were no significant differences in any of the average values among the 3 groups.In the resistance group,the average FBS (5.52 ± 0.52 mmol/L),HbA1 c (5.92 ± 0.36％) and TG (1.65 ± 0.92 mmol/L) had all decreased significantly after the training.In the aerobic group the average waistline,dilated blood pressure,FBG and HbAlc had decreased significantly.In the control group the average 2hrs PBG and LDL-C had both increased significantly compared to 3 months earlier.Compared with the resistance group,the average 2hrs PBGs were significantly higher in both the aerobic and control groups after the training.Moreover,compared with the aerobic group,the value in the control group was also significantly higher.Conclusion Both resistance training and aerobic exercise can lower fasting blood glucose and HbA1 c in PDM patients without obvious effect on BMI or low density lipoprotein level.Compared with aerobic exercises,resistance training had significant advantages in decreasing 2-hour postprandial blood glucose.
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<p><b>BACKGROUND</b>Self-monitoring of blood glucose (SMBG) by individuals with type 2 diabetes (T2D) is crucial for long-term health, yet numerous cultural, economic and health factors can reduce SMBG. Most studies on SMBG adherence have come out of the US and Europe, and their relevance to Asia is unclear. The aims of the present study were to assess the current state of SMBG in China and analyze demographic and diabetes-related characteristics that may influence it.</p><p><b>METHODS</b>In this multi-center, cross-sectional study, 5 953 individuals with T2D from 50 medical centers in 29 provinces across China filled out a standardized questionnaire that requested information on demographic characteristics, education level, occupation, income, lifestyle risk factors, duration of diabetes, chronic complications, and frequency of SMBG. Respondents were also asked whether their glycosylated hemoglobin (HbA1c) had been checked in the past 6 months. The most recent values for fasting plasma glucose, 2-hour postprandial blood glucose and HbA1c were recovered from medical records.</p><p><b>RESULTS</b>Only 1 130 respondents (18.98%) performed SMBG with the recommended frequency, while 4 823 (81.02%) did not. In fact, nearly 2 105 (35.36%) reported never performing SMBG. In the subset of 3 661 individuals on insulin therapy, only 266 (7.27%) performed SMBG at least once a day, while 1 210 (33.05%) never performed it. In contrast, 895 of 2 292 individuals (39.05%) on diet/exercise therapy or oral hypoglycemic therapy never performed it. Multivariate Logistic regression identified several factors associated with SMBG adherence: female gender, higher education level, higher income, longer T2D duration and education about SMBG.</p><p><b>CONCLUSIONS</b>SMBG adherence in our Chinese population with T2D was less frequent than that in developed countries. Several factors influence SMBG adherence: gender, education level, income, T2D duration, therapy regimen and exposure to education about SMBG.</p>
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Adult , Female , Humans , Male , Middle Aged , Blood Glucose , Metabolism , Blood Glucose Self-Monitoring , China , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , BloodABSTRACT
<p><b>BACKGROUND</b>Insulin injection therapy is one of the most effective treatments for type 2 diabetes mellitus (T2DM). Many people with T2DM in western countries resist starting insulin therapy; whether the same is true in China is unknown. This survey-based study assessed acceptance and rejection of insulin therapy among individuals with T2DM in China and self-reported reasons for these therapy choices. It also examined what methods may be useful for increasing the rate of insulin acceptance.</p><p><b>METHODS</b>A multi-center, cross-sectional survey was conducted between April and July 2010 to a convenience sample of inpatients and outpatients at 50 medical centers across 29 administrative divisions in China. Data were collected on sociodemographic and T2DM characteristics, therapy regime, and attitudes toward insulin therapy.</p><p><b>RESULTS</b>A total of 6 043 patients were surveyed, and 5 961 complete questionnaires (98.6%) were used in the analysis. Just over half the respondents (3 460, 58.0%) reported negative attitudes to insulin therapy, including 2 508 of the 4 469 patients (56.1%) whose physicians had recommended it to them. Of the patients counseled to use insulin, 800 (17.9%) were unwilling to start therapy and cited the following reasons: inconvenience (64.3%); concerns over addiction (24.6%); pain (14.3%); side effects (14.1%); and high cost (13.6%). Logistic regression suggested that respondents would be more willing to undertake insulin therapy if they had received diabetes education, had positive attitudes to the treatment, had higher glycosylated hemoglobin level, or had suffered diabetes for a longer period or with more complications.</p><p><b>CONCLUSIONS</b>Patients with T2DM in China are often resistant to insulin therapy if they have been diagnosed with the disease for a relatively short time or if the disease has been relatively mild. Educating patients on the benefits of insulin therapy, not only at the initial diagnosis with T2DM but also when insulin therapy becomes necessary, will likely increase their willingness to undertake it.</p>
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Female , Humans , Male , Middle Aged , China , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Drug Therapy , Insulin , Therapeutic Uses , Patient Acceptance of Health Care , Surveys and QuestionnairesABSTRACT
The article reviewed the effects of resistance training,aerobic exercise in patients with diabetes and pre-diabetes,based on the metabolic characteristics in patients with pre-diabetes,and aimed at providing theoretical reference for exercise in the prevention and control of diabetes mellitus.
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Objective To translate the Female Sexual Function Index(FSFI) into Chinese and establish its psychometric properties among ordinary Chinese people and diabetes patients.Methods A two-phase study design was applied.The Chinese version of FSFI was established by translation and back translation,then the reliability and validity of the FSFI were evaluated.Results The content validity coefficient of FSFI was 0.953.The test-retest reliability in each dimension had good correlations (r value was 0.817～0.922),with the highest correlation coefficient in vaginal lubrication dimension (0.922) and arousal dimension the minimum (0.817).In all samples (including diabetes and non diabetes) a reliability coefficients of the Cronbach alpha of each dimension was from 0.760 to 0.874.The Cronbach alpha of each dimension for the diabetic group was from 0.783 to 0.882,and from 0.757 to 0.865 in the non-diabetes group.Pearson correlation of each dimension was very good in total samples,the diabetes group,and the non-diabetes group.Conclusions The psychometric properties of the FSFI demonstrated satisfactory validity and reliability.The Chinese version of FSFI is a reliable and valid measure to evaluate the sexual function in Chinese women.
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Diabetes mellitus is a worldwide disease and a growing public health burden.Female sexual function in patients with diabetes mellitus is complex and encompasses physical and emotional well-being across the lifespan.This review aims to discuss the development of sexual dysfunction in women with diabetes,while defining the parameters of dysfunction,and to present suggested risk factors and pathogenetic pathways,while offering evidencebased strategies for the evaluation of sexual dysfunction and management.
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objective To explore the effect of diabetes management program with the goal of behavior changes on behavior change and metabolic index of patients with type 2 diabetes mellitus.Methods By setting up the diabetes management team,establishing personalized management file,carrying out education program,setting the goal of behavior changes and evaluating goal's trace,One-year management was carried out for 56 cases of type 2 diabetic patients.Patients' behavior changes were evaluated after six months management and one year later the metabolic indexes were contrasted.Results After 6 months management,the rate of goal achievement was 96%,the rate of one year behavior stabilization was 92%,the body mass index (BMI),fasting and postprandial blood glucose,glycosylated hemoglobin (HbAlc) one year later were decreased dramatically.Conclusions There is important significance of diabetes management program with the goal of behavior changes for behavior changes and metabolic indexes control in type 2 diabetic patients.