Evidence map›Paper›PMID 31830073›Full record

Observational studyPloS one2019

Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report.

Helmuth Haslacher, Hannelore Fallmann, Claudia Waldhäusl, Edith Hartmann, Oswald F Wagner, Werner Waldhäusl

Abstract readObservational Study
In one paragraph

Observational study in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Helmuth HaslacherDepartment for Laboratory Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria.ORCID 0000-0003-4605-2503
Hannelore FallmannRehabilitation Clinic for Diabetes and Metabolic Diseases, Moorbad Neydharting, Neydharting, Neydharting, Austria.
Claudia WaldhäuslDepartment of Radiotherapy, Medical University of Vienna, Waehringer Guertel, Vienna, Vienna, Austria.
Edith HartmannRehabilitation Clinic for Diabetes and Metabolic Diseases, Moorbad Neydharting, Neydharting, Neydharting, Austria.
Oswald F WagnerDepartment for Laboratory Medicine, Medical University of Vienna, Waehringer Guertel, Vienna, Austria.
Werner WaldhäuslRehabilitation Clinic for Diabetes and Metabolic Diseases, Moorbad Neydharting, Neydharting, Neydharting, Austria.ORCID 0000-0003-4024-1709

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOutcome of type 2 diabetes care depends on the acceptance of self-responsibility by informed patients, as treatment goals will otherwise be missed. AIMS AND

methodsThis pre/post-observational report describes the clinical outcome of type 2 diabetes care in patients with type 2 diabetes (N =930) admitted consecutively to a diabetes rehabilitation clinic (DRC) between June 2013, and June 2016, where they were exposed to standardized lifestyle modification with meals low in salt and rich in vegetables and fruits, totaling 1,200 to 1,600 kcal/d, and an add-on exercise load equivalent to 400-600 kcal/d.

resultsAt admission, patients presented with multiple treatment modes, elevated HbA1c levels (7.6±1.5%, 60±16 mmol/mol), a high prevalence of co-morbidities dominated by obesity (79%), a low rate of influenza and pneumococcal immunization (<9%) and underuse of lipid-lowering drugs (-29%). Analysis of clinical and metabolic outcome after 3 weeks shows that simple standardization of and better adherence to treatment recommendations improved (p<0.0001) glucose (HbA1c -0.4±0.4%) and lipid metabolism (LDL/HDL ratio, -0.58±0.03), permitting a 39% reduction in insulin dosage, omission of insulin in 36/232 patients and omission of oral antidiabetic drugs (OADs) other than metformin and DPP4-inhibitors, while the use of GLP-1 analogs doubled to 5.2%. Improved outcome was independent of treatment strategy and more marked at initially high HbA1c at costs less than 25% of those encountered at a standard hospital.

conclusionsOur observations support the clinical notion that adherence to basic treatment recommendations is indispensable in type 2 diabetes care if metabolic and clinical treatment goals are to be met, and if inappropriate add-on over-medicalization with OADs and/or insulin is to be avoided. To this end, 'imprinting' patients at a DRC could be of considerable help.

Indexed as

Quality ImprovementAdultAgedDelivery of Health CareDiabetes Mellitus, Type 2FemaleHospitals, RehabilitationHumansHypoglycemic AgentsMaleMiddle AgedStandard of CareTreatment OutcomeYoung AdultHypoglycemic Agents

Identifiers

PMID31830073
PMCPMC6907777

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.