title: Gender, diabetes education, and psychosocial factors are associated with persistent poor glycemic control in patients with type 2 diabetes in the Joint Asia Diabetes Evaluation (JADE) program.
abstract: BACKGROUND
  Factors associated with persistent poor glycemic control were explored in patients with type 2 diabetes under the Joint Asia Diabetes Evaluation (JADE) program.
  
  
  METHODS
  Chinese adults enrolled in JADE with HbA1c ≥8% at initial comprehensive assessment (CA1) and repeat assessment were analyzed. The improved group was defined as those with a ≥1% absolute reduction in HbA1c, and the unimproved group was those with <1% reduction at the repeat CA (CA2).
  
  
  RESULTS
  Of 4458 enrolled patients with HbA1c ≥8% at baseline, 1450 underwent repeat CA. After a median interval of 1.7 years (interquartile range[IQR] 1.1-2.2) between CA1 and CA2, the unimproved group (n = 677) had a mean 0.4% (95% confidence interval [CI] 0.3%, 0.5%) increase in HbA1c compared with a mean 2.8% reduction (95% CI -2.9, -2.6%) in the improved group (n = 773). The unimproved group had a female preponderance with lower education level, and was more likely to be insulin treated. Patients in the improved group received more diabetes education between CAs with improved self-care behaviors, whereas the unimproved group had worsening of health-related quality of life at CA2. Apart from female gender, long disease duration, low educational level, obesity, retinopathy, history of hypoglycemia, and insulin use, lack of education from diabetes nurses between CAs had the strongest association for persistent poor glycemic control.
  
  
  CONCLUSIONS
  These results highlight the multidimensional nature of glycemic control, and the importance of diabetes education and optimizing diabetes care by considering psychosocial factors.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Junmei
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.|Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Roseanne
authors.initials: R
authors.lastname: Yeung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.|Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Andrea
authors.initials: A
authors.lastname: Luk
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Greg
authors.initials: G
authors.lastname: Tutino
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Yuying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.|Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Alice
authors.initials: A
authors.lastname: Kong
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.|Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Harriet
authors.initials: H
authors.lastname: Chung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.|Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Ronald
authors.initials: R
authors.lastname: Ma
authors.affiliation: Diabetes Center, Alice Ho Nethersole Hospital, Hong Kong SAR, China.
authors.forename: Chiu-Chi
authors.initials: CC
authors.lastname: Tsang
authors.affiliation: Qualigenics Diabetes Centre, Hong Kong SAR, China.
authors.forename: Peter
authors.initials: P
authors.lastname: Tong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Wingyee
authors.initials: W
authors.lastname: So
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.|Li Ka Shing Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.|Diabetes and Endocrine Centre, Prince of Wales Hospital, Hong Kong SAR, China.|Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China.|Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Juliana
authors.initials: J
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000523:psychology; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D007003:Hypoglycemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000592:standards*; D012737:Sex Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: 2型糖尿病; diabetes education; persistent poor glycemic control; psychosocial factors; quality improvement; type 2 diabetes; 持续血糖控制不佳; 社会心理因素; 糖尿病教育; 质量改进