Effects of health-information-based diabetes shared care program participation on preventable hospitalizations in Taiwan

Social determinants of health and type 2 diabetes in Asia

Type 2 diabetes mellitus (T2DM) is a major global public health challenge driven by a complex interplay of genetic, environmental, and social factors. This review highlights the effects of social determinants of health (SDOH) on T2DM in Asia, where rapid urbanization, worsening air pollution, and distinct socioeconomic structures uniquely influence disease outcomes. Key SDOH domains, socioeconomic status (education, income, and occupation), physical environment, food environment, healthcare access, and social context, were analyzed for their associations with T2DM prevalence, progression, and management. Among these, environmental and lifestyle shifts have emerged as particularly influential factors in Asia. Air pollution, particularly fine particulate matter, has been increasingly linked to insulin resistance and diabetes risk in Asian populations. Additionally, rapid urbanization and changing food environments contribute to rising T2DM incidence through shifts in lifestyle and dietary patterns. Across the diverse healthcare systems of Asian countries, primary care remains a universally critical component in addressing T2DM issues. Additionally, social capital and cohesion serve as protective factors, whereas social isolation heightens vulnerabilities. These insights underscore the importance of addressing SDOH in public health strategies to combat T2DM in Asia. Future research should prioritize longitudinal studies and culturally tailored interventions to reduce the region's diabetes burden.

Medication refills do not guarantee medication intake: translation and validation of the Adherence to Refills and Medications Scale in Traditional Chinese among individuals with type 2 diabetes in Taiwan

OBJECTIVE

This study aimed to translate and validate the Adherence to Refills and Medications Scale into Traditional Chinese (ChARMS-T) and to investigate common barriers to medication adherence among patients with type 2 diabetes (T2D) in Taiwan.

METHODS

The ChARMS-T was developed through translation and application phases. During the translation phase, the scale underwent forward translation, backward translation, and cognitive debriefing. In the application phase, the finalized ChARMS-T was administered to patients with T2D at five Taiwan community pharmacies over eleven months starting in June 2023. Psychometric properties were assessed using criterion validity, construct validity through confirmatory factor analysis, and reliability through McDonald's omega.

RESULTS

A total of 343 participants completed surveys. Factor analysis of the 12-item ChARMS-T revealed two dimensions: medication-taking (8 items) and medication refill (4 items). The instrument demonstrated acceptable internal consistency, with McDonald's omega scores of 0.841 for medication-taking and 0.647 for medication refill. The medication refill subscale showed strong agreement with the objective refill measure, proportion of days covered, with a coefficient of 0.84, suggesting that these measures evaluate similar constructs. Evidence of known-groups validity was demonstrated by a significant difference between ChARMS-T scores and glycemic control (p = 0.047). Patients with good glycemic control had a significantly higher adherence rate to both refills and medication-taking compared to those with poor glycemic control. The most frequently reported barriers to medication-taking were carelessness (55.7%), forgetfulness (54.8%), and frequent dosing intervals (43.1%). For medication refills, 9.6% of the participants identified a lack of planning as the main reason for not refilling their diabetes medications on time, followed by forgetfulness (7.6%).

CONCLUSIONS

The ChARMS-T identified a broader range of non-adherence reasons and demonstrated good psychometric properties. It can be integrated into practice settings for screening and follow-up to enhance medication adherence through effective communication between healthcare professionals and patients, ultimately improving long-term patient health outcomes.

Does financial incentive for diabetes management in the primary care setting reduce avoidable hospitalizations and mortality in high-income countries? A systematic review

Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.

Efficacy of a health education technology program in improving adherence to self-management behaviors and quality of life among adults with type 2 diabetes: A randomized controlled trial

AIM

This study examined the efficacy of a health education technology program on self-management adherence behavior and quality of life among people with type 2 diabetes (T2D).

METHODS

A randomized experimental study design was employed. A total of 110 subjects was recruited. The experimental group received a novel technology education program plus routine shared care. The control group received routine shared care alone. Quality of life and adherence to self-management behavior questionnaires were used to measure outcomes. A linear mixed-effects model was used to analyze changes in quality of life after controlling for pre-test effects. The odds ratio was calculated for differences in adherence behavior between the two groups.

RESULTS

The between-group mean difference in quality of life scores and adherence to physical activity comparing pre-test at 3 months follow-up showed significant progress at 3 months post-test compared with the control group. However, the increase in mean quality of life scores and adherence behavior at 6 months did not demonstrate a sustained between-group difference.

CONCLUSION

The results showed adherence to physical activity and improved quality of life in patients with T2D at 3 months post intervention. Therefore, the program can be used as an intensive model for diabetes shared care.

Effect of Taiwan's Diabetes Shared Care Program on the risk of periprosthetic joint infection after total joint arthroplasty in patients with type 2 diabetes mellitus: an eight-year population-based study

BACKGROUND

Periprosthetic joint infection (PJI) is a significant post-arthroplasty complication for diabetic patients, with uncontrolled diabetes identified as a PJI risk factor. Taiwan's Diabetes Shared Care Program (DSCP) was established for holistic diabetes care.

AIM

To evaluate the DSCP's impact on PJI incidence and patients' medical costs.

METHODS

Data were analysed from Taiwan's National Health Insurance Research Database from 2010 to 2020, focusing on type 2 diabetes mellitus (DM) patients who had undergone arthroplasty. The study group involved DSCP participants, while a comparison group comprised non-participants with matched propensity scores for age, sex, and comorbidities. The primary outcome was the PJI incidence difference between the groups; the secondary outcome was the medical expense difference.

FINDINGS

The study group consisted of 11,908 type 2 DM patients who had arthroplasty and joined the DSCP; PJI occurred in 128 patients. Among non-participants, 184 patients had PJI. The PJI incidence difference between the groups was statistically significant (1.07% vs 1.55%). The study group's medical costs were notably lower, regardless of PJI incidence. Multivariate regression showed higher PJI risk in patients in comparison group, aged >70 years, male, or who had obesity, anaemia.

CONCLUSION

The study indicates that DSCP involvement reduces PJI risks and decreases annual medical costs for diabetic patients after arthroplasty. Consequently, the DSCP is a recommendable option for such patients who are preparing for total joint arthroplasty.

Protocatechuic Acid Ameliorates High Fat Diet-Induced Obesity and Insulin Resistance in Mice

SCOPE

Insulin resistance is a common feature of obesity and type 2 diabetes and partly results from an imbalance between food intake and energy expenditure. Therefore, efficient and safe insulin resistance treatment therapies are warranted. This work is aim to access the impact of protocatechuic acid (PCA), a catechol-type O-diphenol phenolic acid, in high fat diet (HFD)-induced glucose, and lipid dysregulation.

METHODS AND RESULTS

Five-week-old male C57BL/6 mice are fed with HFD for 4 weeks and then are randomly divided into two cohorts: one cohort feed with HFD is free access to sterile water for 4 weeks, another cohort is free access to PCA-containing water (2.7 mM) for 4 weeks with HFD. In this study, using a hyperinsulinemic-euglycemic mouse clamp, it is showed that PCA-treated mice display improved systemic insulin resistance via enhanced fatty acid mobilization and utilization, thereby reducing ectopic lipid accumulation and promoting hepatic and peripheral insulin action.

CONCLUSIONS

This study provides insights on the potent pharmacological effects of PCA from food sources on improving high fat diet (HFD)-induced whole-body insulin resistance and type 2 diabetes.

Does health information affect lifestyle behaviours? The impact of a diabetes diagnosis

Despite an increasing interest in the effect of health information on health-behaviours, evidence on the causal impact of a diagnosis on lifestyle factors is still mixed and does not often account for long-term effects. We explore the role of health information in individual health-related decisions by identifying the causal impact of a type-2 diabetes diagnosis on body mass index (BMI) and lifestyle behaviours. We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value in the diagnosis of type-2 diabetes provided by a biomarker (glycated haemoglobin) drawn from unique administrative longitudinal data from Spain. We find that following a type-2 diabetes diagnosis individuals appear to reduce their weight in the short-term. Differently from previous studies, we also provide evidence of statistically significant long-term impacts of a type-2 diabetes diagnosis on BMI up to three years from the diagnosis. We do not find perceivable effects of a type-2 diabetes diagnosis on quitting smoking or drinking. Overall, health information appears to have a sustained causal impact on weight reduction, a key lifestyle and risk factor among individuals with type-2 diabetes.

Impact of integrated health care on elderly population: A systematic review of Taiwan's experience

BACKGROUND

Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population.

METHODS

We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies.

RESULTS

Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures.

CONCLUSION

The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials.

Exploration of Preventable Hospitalizations for Colorectal Cancer with the National Cancer Control Program in Taiwan

Background: Causing more than 40,000 deaths each year, cancer is one of the leading causes of mortality and preventable hospitalizations (PH) in Taiwan. To reduce the incidence and severity of cancer, the National Cancer Control Program (NCCP) includes screening for various types of cancer. A cohort study was conducted to explore the long-term trends in PH/person-years following NCCP intervention from 1997 to 2013. Methods: Trend analysis was carried out for long-term hospitalization. The Poisson regression model was used to compare PH/person-years before (1997–2004) and after intervention (2005–2013), and to explore the impact of policy intervention. Results: The policy response reduced 26% for the risk of hospitalization; in terms of comorbidity, each additional point increased the risk of hospitalization by 2.15 times. The risk of hospitalization doubled for each 10-year increase but was not statistically significant. Trend analysis validates changes in the number of hospitalizations/person-years in 2005. Conclusions: PH is adopted as an indicator for monitoring primary care quality, providing governments with a useful reference for which to gauge the adequacy, accessibility, and quality of health care. Differences in PH rates between rural and urban areas can also be used as a reference for achieving equitable distribution of medical resources.

Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial

AIMS

This study aimed to explore the effects of a health technology education program on long-term glycemic control and the self-management ability of adults with type 2 diabetes (T2D).

METHODS

The study was a randomized controlled trial with repeated measures design. The experimental group (n = 53) received a novel health technologies education program plus focus groups and routine shared care, the control group (n = 55) received routine shared care. Glycosylated hemoglobin (HbA1c) level and self-management ability were the primary and secondary outcomes. Subject self-management ability was evaluated using the Chinese version of Perceived Diabetes Self-Management Scale (PDSMS). A linear mixed-effect model for repeated measures was used to analyze changes in HbA1c level and self-management ability after controlling for pretest effects.

RESULTS

The mean HbA1c levels in the experimental group decreased by 0.692% (7.564 mmol/mol) and 0.671% (7.332 mmol/mol) at 3 and 6 months after the intervention (p < 0.05) while the mean increase in the PDSMS scores at 3 and 6 months after the intervention were significantly higher than those in the control group (p < 0.05).

CONCLUSION

The health technology education program was more effective than routine shared care alone in lowering HbA1c and increasing self-management ability in T2D patients.

Social Determinants of Diabetes-Related Preventable Hospitalization in Taiwan: A Spatial Analysis

Diabetes-Related Preventable Hospitalization (DRPH) has been identified as an important indicator of efficiency and quality of the health system and can be modified by social determinants. However, the spatial disparities, clustering, and relationships between DRPH and social determinants have rarely been investigated. Accordingly, this study examined the association of DRPH with area deprivation, densities of certificated diabetes health-promoting clinics (DHPC) and hospitals (DHPH), and the presence of elderly social services (ESS) using both statistical and spatial analyses. Data were obtained from the 2010-2016 National Health Insurance Research Database (NHIRD) and government open data. Township-level ordinary least squares (OSL) and geographically weighted regression (GWR) were conducted. DRPH rates were found to be negatively associated with densities of DHPC (β = -66.36, p = 0.029; 40.3% of all townships) and ESS (β = -1.85, p = 0.027; 28.4% of all townships) but positively associated with area deprivation (β = 2.96, p = 0.002; 25.6% of all townships) in both OLS and GWR models. Significant relationships were found in varying areas in the GWR model. DRPH rates are high in townships of Taiwan that have lower DHPC densities, lower ESS densities, and greater socioeconomic deprivation. Spatial analysis could identify areas of concern for potential intervention.

The challenges of nursing information systems: a narrative review of the literature

Nursing information systems, where quality indicators are integrated, focus on the standardization of health records and the consequent visibility of the provided care. Despite the acknowledged importance of the contributions of information systems, their implementation has been characterized by several challenges, so we propose to reflect on them. To identify the evidence available in the literature on these same challenges, a narrative review of the literature was developed, with the analysis of relevant articles and reports on this issue. It is clear in the literature the importance of information systems for obtaining quality indicators that are sensitive to nursing care, with a positive impact on the quality of care, allowing for measurable quality in interventions, as well as facilitating inter and intra-institutional comparability, in real-time or in a retrospective analysis. The challenges encountered and which urgently needs to be resolved in clinical practice are related to the difficulty for professionals to perceive the impact of computer records, the visibility of nursing indicators and the time that is allocated in the context of providing care to carry out these records.