Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China / 中华流行病学杂志

Objective: To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China. Methods: In this cluster randomized controlled trial, a total of 799 T2DM patients with most recent hemoglobin A1c (HbA1c) ≥ 7.5% (or fasting plasma glucose level ≥10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai, and randomized into a health literacy intervention group, an exercise intervention group, a comprehensive intervention group and a control group. After baseline survey and examination, a one-year intervention and 3 times (at 3(rd), 6(th), and 12(th) month) follow-up surveys were conducted. Results: The follow-up rates for all the subjects were 99.4%, 98.4% and 95.2%, respectively, at 3(rd), 6(th) and 12(th) month. Patients in intervention groups were more likely to achieve a goal HbA1c level (HbA1c <7.0%) than those in control group, with the highest glycemic control rate (25.3%) observed in comprehensive intervention group at 3(rd) month and then in exercise intervention group (25.3% and 34.6%) respectively, at 6(th) month and 12(th) month. The average levels of HbA1c in three intervention groups were lower at each follow-up time point than those at baseline survey. However, the decreases in HbA1c were obvious only at 6(th) month (P<0.001), with ls-mean (95%CI) of -0.48% (-0.71%, -0.25%), -0.33% (-0.55%, -0.11%) and -0.70% (-0.92%, -0.48%), respectively, in comprehensive, health literacy and exercise intervention groups, but it increased slightly by 0.03% (-0.19%, 0.25%) in control group. Compared with control group, the interventions were significantly associated with the decrease of HbA1c level, with the most improvement observed in comprehensive group (β=-0.47, 95% CI: -0.73, -0.20) at 3(rd) month, and in exercise intervention group at 6(th) month (β=-0.73, 95%CI: -0.98, -0.47) and at 12(th) month (β=-0.75, 95%CI: -1.05, -0.45) of follow-up. Stratified analyses showed that patients with lower health literacy level could benefit from any intervention, while those with higher numeracy skill benefited more from exercise intervention. Conclusion: Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM, which would be helpful in reducing the risks of complications and deaths in diabetes patients.

Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China / 中华流行病学杂志

Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.

Birth weight and subsequent risk of type 2 diabetes across two generations in Chinese females / 中华流行病学杂志

Objective To evaluate the association between birth weight and subsequent risk of type 2 diabetes (T2DM) across two generations in Chinese females.Methods A cross-sectional survey was conducted among 10 324 blood-related females in Shanghai from November 2012 to January 2013.A structured questionnaire was used to collect data about demographic information,birth weight,lifestyle factors and diagnosis of T2DM.Path analysis was performed to estimate the matemal effect of birth weight and diabetes status on their offspring,and mediation analysis was conducted to test whether birth weight mediates the association between maternal and daughters' diabetes status.Results A positive association was observed between maternal and daughters' birth weight.One kg increase in maternal birth weight was associated with an average of 0.335 (95％CI:0.307-0.363) kg elevated birth weight in female offspring.Maternal diabetes status was also related with an average of 0.066 (95％ CI:0.025-0.107) kg increase in birth weight and tripled risk of subsequent T2DM (OR=3.173,95％CI:1.946-5.174) in female offspring.In all subjects aged ≥20 years,no significant relationship was observed between birth weight and risk of T2DM subsequently after adjusting for age.Offspring' s birth weight,as a mediator of maternal and daughters' diabetes status,explained 2.8％ of their association.Conclusion Maternal birth weight and diabetes status may influence their female offspring' s birth weight and subsequent risk of T2DM.