Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan

The Impact of Diabetes Self-Care, Healthy Lifestyle, Social Support, and Demographic Variables on Outcomes HbA1c in Patients With Type 2 Diabetes

Background

Controlling HbA1c can help reduce the symptoms and complications of diabetes. However, only about 25% of adults with diabetes achieve this diabetes care goal. It can be seen that diabetes requires more research investment and breakthroughs, as well as a more complete discussion of related factors that affect diabetes control, in order to better control the disease. This study explored the effects of diabetes self-care behavior, healthy lifestyle, diabetes symptoms, social support, demographic variables, and physical examination values on HbA1c levels in individuals with type 2 diabetes.

Methods

This study used a cross-sectional design and recruited 305 subjects with type 2 diabetes at a medical center. Personal data were collected using a structured questionnaire and same-day outpatient medical records.

Results

Multiple linear regression analysis identified significant predictors of HbA1c levels. These include insulin treatment (P < .001), age (P < .001), gender (P < .001), diabetes duration (P = .003), proteinuria (P < .001), diabetes self-care behaviors (P = .021), physical activity (running; P = .018), and spousal involvement in care (P = .031). Female gender, insulin treatment, longer diabetes duration, spousal involvement in care, and the presence of proteinuria were positively associated with higher HbA1c levels. In contrast, higher age, better diabetes self-care behaviors, and regular physical activity (running) were associated with lower HbA1c levels. These findings underscore the importance of considering both demographic factors and lifestyle behaviors in the management of HbA1c levels.

Conclusions

For reasons that hinder subjects from controlling HbA1c levels, individual self-management intervention programs should be provided to improve the effectiveness of subjects in controlling HbA1c levels. The care giver should be included in the educational program of diabetes management. Running exercise contributes to the control of HbA1c levels.

Market concentration of the Brazilian hospital medical supplementary health system

BACKGROUND

The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic.

OBJECTIVE

To understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions.

METHODOLOGY

The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The data are organized into three groups: historical and regulatory documents; industry data; and market.

RESULTS

The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing and the prevalence of corporate health plans.

CONCLUSION

The growing concentration of the system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. This denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.

Establishment of reference interval for hemoglobin A1C and other hemoglobin subfractions for healthy Saudi adults

BACKGROUND

The establishment of Reference Intervals (RIs) for Hemoglobin A1C and other hemoglobin subfractions (A1A, A1B, F, LA1C, A0) is of utmost importance in screening, diagnosing, and monitoring diabetes and other hemoglobin abnormalities through the application of high-pressure liquid chromatography (HPLC) technique. Because there are no locally established RIs for these parameters, it is essential to establish RIs specific to the Saudi population to accurately diagnose and monitor diabetic individuals and identify abnormal levels in hemoglobin subfractions.

METHODS

As part of the IFCC global multicenter study of laboratory reference values, a cross-sectional study was conducted in Saudi Arabia. The study involved recruiting a total of 381 healthy adult subjects (>18 years, BMI 28.3 ± 6 kg/m2). Blood samples were analyzed for A1C, biochemical and other immunoassay parameters. The need for RIs based on sex, age, and BMI was determined using the standard deviation ratio (SDR) through a 3-level nested ANOVA.

RESULTS

Based on the threshold of SDR≥0.4, RIs for A1C and other Hb subfractions were not partitioned by sex or BMI, but partitioned by age (<45 & ≥45 years) for A1C, LA1C, A0 and F. Spearman's correlation between glucose, insulin, and C-peptide showed a positive association with different hemoglobin subtractions of A1B, F, A1C, and LA1C. The RIs were obtained by using the parametric method and the latent abnormal values exclusion (LAVE) principle was applied on A1C.

CONCLUSION

This study established RIs for A1C and other Hb subfractions for healthy adult Saudis. Age was found to be an important source of variation for most of the parameters including A1C. These findings will enhance the understanding and clinical decision-making concerning A1C and other hemoglobin subfractions. The elevated upper limit of RIs for A1C reflects the high prevalence of diabetes in the Saudi population specially in those with increased age.

Analysis of the Relationship between National Image Building and International Communication Ability from the Perspective of Ecology under the Media Environment

With the gradual expansion of China's political, economic, and military strength, the rapid rise of China has become a globally recognized fact. At present, although China's international image as the world's second largest economy, military power, and political power has been increasingly accepted by the global community, China's image construction, as an important part of national soft power, is still facing many problems. This chapter focuses on defining the basic concepts of international publicity, China's soft power, and China's image construction in the context of new media integration, analyzes the international development trend of international publicity and the important functions and limitations of foreign publicity in establishing China's image construction, and analyzes the ecological environment of media integration development. Considering that there are great unfairness in the environment and the conflict of communication values is not conducive to the establishment of China's urban image, the article focuses on how to use global publicity values to establish China's national image and puts forward corresponding countermeasures.

Nursing-Intense Health Education Intervention for Persons with Type 2 Diabetes: A Quasi-Experimental Study

Type 2 diabetes mellitus (DM2) is a highly prevalent disease, the progression of which depends on high blood glucose levels, which are reflected in the level of glycosylated haemoglobin (HbA1c). Appropriate health education equips patients with the knowledge and skills to control their glucose and HbA1c levels to avoid long-term complications. This study was set up to compare the results of an intensive (360 min) educational intervention to improve HbA1c parameters in patients with DM2 with those of a usual 90 min intervention. For this purpose, healthcare personnel led a quasi-experimental study of 249 diabetics: 171 in the control group, and 78 in the intervention group. In the control group, the mean HbA1c value decreased from 6.97 to 6.75, while in intervention group it fell from 8.97 to 8.06. The before and after mean difference between both groups was compared with a Wilcoxon test, and the results statistically significant (W = 4530; p < 0.001), indicating a higher reduction of HbA1c in the intervention group. We concluded that the intensive health education provided by nurses during the consultation helped improve HBA1c levels in persons with DM2.