Development of and Assessment Algorithm and an Intervention Program based on Characteristics of Health Risk used for the Type 2 Diabetes Disease Management

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1. PurposeA 12-month-self-management program for type 2 Diabetes was developed, whose effects were examined at hospitals and in a community. At the community level, the possibility of a system was examined where the program was implemented by the insured through tertiary prevention.2. Method(1) Implementation at the hospitals: A randomized clinical trial was conducted with the subjects who were type 2 diabetes, were outpatients at two hospitals and gave consent to participating in the study. The program was implemented to the intervention group with a monthly interview of 30 minutes and a biweekly telephone monitoring. The outcome indicators measured were the goal achievement level, the behavioral transformation stages (diet and exercise), self-efficacy, QOL, HbA1c, weight, blood pressure, abdominal circumference, fasting blood sugar, triglyceride and total cholesterol.(2) Implementation in the community: A nonrandomized, before-after trial was conducted with the subjects who were comm … More unity residents, screened by abnormal glucose tolerance during the annual health check-up, type-2 diabetes and gave consent to participation in the study. The intervention method and the outcome indicators were the same as those for the medical institution.3. Results(1) Implementation at the medical institution: There were 50 subjects in the intervention group and 25 in the control group, of whom 8 from the former and 2 from the latter groups dropped out (the program completion rate 84.0%). At the baseline, 3-month, 6-month, 9-month and 12-month (end) points, there were statistically significant interactions between the HbA1c value and self-efficacy. Differences between the two groups were significant in terms of the dietary stage and QOL. There were significant within-group differences between the weight, HbA1c, dietary and exercise stages, and self-efficacy. There was a less-than-10% significant differences between the diastolic pressure, T-cho and QOL. In terms of diachronic change, significant differences were observed only for the interventional group, where significant improvements were observed for the weight, abdominal circumference, HbA1c, diastolic pressure, dietary stage, QOL, and self-efficacy.(2) Implementation in the community : There were 33 individuals signed up for the program with one person dropping out because of development of complications and being considered ineligible for the study. There was a significant statistical improvement for all the indicators, particularly the abdominal circumference, QOL, self-efficacy, and dietary and exercise stages. Collaboration with the medical institution was very good, and advantages were observed in terms of implementation by the insured through tertiary prevention. Less