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Zhao R, Zhang X, Wang S, Zhao N, Li D, Fan H. Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China. Int J Equity Health 2023; 22:223. [PMID: 37858125 PMCID: PMC10588159 DOI: 10.1186/s12939-023-02028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services. METHODS A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables. RESULTS 430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior. CONCLUSION The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.
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Affiliation(s)
- Ran Zhao
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Xia Zhang
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Sizhe Wang
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Nan Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Dianjiang Li
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Hong Fan
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
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Zhong Q, Chen Y, Luo M, Lin Q, Tan J, Xiao S, Willey JA, Chen JL, Whittemore R, Guo J. The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial. Global Health 2023; 19:6. [PMID: 36703168 PMCID: PMC9881320 DOI: 10.1186/s12992-023-00910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM). METHODS We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model. RESULTS The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05). CONCLUSIONS Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide. TRIAL REGISTRATION Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.
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Affiliation(s)
- Qinyi Zhong
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
- grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Science, University of Manchester, Manchester, Greater Manchester M13 9PL UK
| | - Yao Chen
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
| | - Mengchun Luo
- Maternal and Child Health Hospital of Yongding, Zhangjiajie, Hunan 427000 People’s Republic of China
| | - Qian Lin
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - Jianghong Tan
- grid.501248.aZhuzhou Central Hospital, Zhuzhou, Hunan 412000 People’s Republic of China
| | - Shuiyuan Xiao
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - James Allen Willey
- grid.266102.10000 0001 2297 6811Department of Family and Community Medicine, University of California, San Francisco, CA 94118 USA
| | - Jyu-Lin Chen
- grid.266102.10000 0001 2297 6811School of Nursing, University of California, San Francisco, CA 94118 USA
| | - Robin Whittemore
- grid.47100.320000000419368710School of Nursing, Yale University, New Haven, CT 06520 USA
| | - Jia Guo
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
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Chen Y, Zhong Q, Luo J, Tang Y, Li M, Lin Q, Willey JA, Chen JL, Whittemore R, Guo J. The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1156-1168. [PMID: 35773443 PMCID: PMC9489585 DOI: 10.1007/s11121-022-01392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 12/08/2022]
Abstract
This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.
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Affiliation(s)
- Yao Chen
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Qinyi Zhong
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Mingshu Li
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - Qian Lin
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - James Allen Willey
- Philip R. Lee Institute for Health Policy Research, University of California, San Francisco, San Francisco, CA, 94118, USA
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA
| | | | - Jia Guo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China.
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Kang Y, Huang H, Li H, Sun W, Zhang C. Functional genetic variants in the 3'UTR of PTPRD associated with the risk of gestational diabetes mellitus. Exp Ther Med 2021; 21:562. [PMID: 33850534 DOI: 10.3892/etm.2021.9994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/20/2020] [Indexed: 11/06/2022] Open
Abstract
A previous study revealed that protein tyrosine phosphatase receptor type D (PTPRD) is highly associated with diabetes mellitus, particularly for type 2 diabetes, through a genome-wide association study. However, the influence of the human polymorphism in the 3'-untranslated region (3'-UTR) of PTPRD on gestational diabetes mellitus (GDM) has remained to be defined. The present study focused on the functional polymorphism located in the 3'-UTR of PTPRD and whether it is associated with the susceptibility to develop GDM. A total of 1,100 pregnant female patients aged between 28 and 36 years within gestational weeks 24-28 were recruited. The participants enrolled in the study comprised 500 cases of GDM and 600 normal controls. Based on the screening results, the single nucleotide polymorphism (SNP) rs56407701 exhibited the most significant difference and may increase the susceptibility to GDM. A prediction of target microRNAs (miRNAs/miRs) using the miRNA SNP database indicated that SNP rs56407701 may be bound by miR-450a, causing the suppression of PTPRD expression in subjects with the GC or CC genotype. In conclusion, The CC genotype of PTPRD rs56407701, which may be bound by miR-450a, may increase the susceptibility of Chinese Han females to GDM during pregnancy. The present study provided a theoretical basis for the SNP rs56407701 being a source of GDM susceptibility loci.
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Affiliation(s)
- Yan Kang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Huamin Huang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Haipeng Li
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Wenping Sun
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Cuicui Zhang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
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