Web-Based TangPlan and WeChat Combination to Support Self-management for Patients With Type 2 Diabetes: Randomized Controlled Trial.

BACKGROUND: China has the largest number of patients with type 2 diabetes mellitus (T2DM) in the world. However, owing to insufficient knowledge of self-management in patients with diabetes, blood glucose (BG) control is poor. Most diabetes-related self-management applications fail to bring significant benefits to patients with T2DM because of the low use rate and difficult operation. OBJECTIVE: This study aims to examine the effectiveness of the combination of the self-designed web-based T2DM management software TangPlan and WeChat on fasting BG (FBG), glycated hemoglobin (HbA1c), body weight, blood pressure (BP), and lipid profiles in patients with T2DM over a 6-month period. METHODS: Participants were recruited and randomized into the TangPlan and WeChat or control groups. Participants in the control group received usual care, whereas the TangPlan and WeChat participants received self-management guidance with the help of TangPlan and WeChat from health care professionals, including BG self-monitoring; healthy eating; active physical exercise; increasing medication compliance; and health education during follow-ups, lectures, or web-based communication. They were also asked to record and send self-management data to the health care professionals via WeChat to obtain timely and effective guidance on diabetes self-management. RESULTS: In this study, 76.9% (120/156) of participants completed the 6-month follow-up visit. After the intervention, FBG (mean 6.51, SD 1.66 mmol/L; P=.048), HbA1c (mean 6.87%, SD 1.11%; P<.001), body weight (mean 66.50, SD 9.51 kg; P=.006), systolic BP (mean 127.03, SD 8.00 mm Hg; P=.005), diastolic BP (mean 75.25, SD 5.88 mm Hg; P=.03), serum low-density lipoprotein cholesterol (mean 2.50, SD 0.61 mmol/L; P=.006), and total cholesterol (mean 4.01, SD 0.83 mmol/L; P=.02) in the TangPlan and WeChat group were all significantly lower, whereas serum high-density lipoprotein cholesterol (mean 1.20, SD 0.25 mmol/L; P=.01) was remarkably higher than in those in the control group. Compared with the baseline data, significance was found in the mean change in FBG (95% CI -0.83 to -0.20; P=.002), HbA1c (95% CI -1.92 to -1.28; P<.001), body weight (95% CI -3.13 to -1.68; P<.001), BMI (95% CI -1.10 to -0.60; P<.001), systolic BP (95% CI -7.37 to -3.94; P<.001), diastolic BP (95% CI -4.52 to -2.33; P<.001), triglycerides (95% CI -0.16 to -0.03; P=.004), serum low-density lipoprotein cholesterol (95% CI -0.54 to -0.30; P<.001), and total cholesterol (95% CI -0.60 to -0.34; P<.001) in the TangPlan and WeChat group but not in the control group (P=.08-.88). CONCLUSIONS: Compared with usual care for patients with T2DM, the combination of TangPlan and WeChat was effective in improving glycemic control (decrease in HbA1c and BG levels) and serum lipid profiles as well as reducing body weight in patients with T2DM after 6 months. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000028843; https://tinyurl.com/559kuve6.

Healthcare needs, experiences and treatment burden in primary care patients with multimorbidity: An evaluation of process of care from patients' perspectives.

BACKGROUND: Patients with multimorbidity often experience treatment burden as a result of fragmented, specialist-driven healthcare. The 'family doctor team' is an emerging service model in China to address the increasing need for high-quality routine primary care. OBJECTIVE: This study aimed to explore the extent to which treatment burden was associated with healthcare needs and patients' experiences. METHODS: Multisite surveys were conducted in primary care facilities in Guangdong province, southern China. Interviewer-administered questionnaires were used to collect data from patients (N = 2160) who had ≥2 clinically diagnosed long-term conditions (multimorbidity) and had ≥1 clinical encounter in the past 12 months since enrolment registration with the family doctor team. Patients' experiences and treatment burden were measured using a previously validated Chinese version of the Primary Care Assessment Tool (PCAT) and the Treatment Burden Questionnaire, respectively. RESULTS: The mean age of the patients was 61.4 years, and slightly over half were females. Patients who had a family doctor team as the primary source of care reported significantly higher PCAT scores (mean difference 7.2 points, p < .001) and lower treatment burden scores (mean difference -6.4 points, p < .001) when compared to those who often bypassed primary care. Greater healthcare needs were significantly correlated with increased treatment burden (ß-coefficient 1.965, p < .001), whilst better patients' experiences were associated with lower treatment burden (ß-coefficient -0.252, p < .001) after adjusting for confounders. CONCLUSION: The inverse association between patients' experiences and treatment burden supports the importance of primary care in managing patients with multimorbidity. PATIENT CONTRIBUTION: Primary care service users were involved in the instrument development and data collection.

Body Constitution and Unhealthy Lifestyles in a Primary Care Population at High Cardiovascular Risk: New Insights for Health Management.

BACKGROUND: Adherence to lifestyle recommendations remains insufficient in cardiovascular (CV) health management globally. Body constitution, from the perspective of traditional Chinese medicine, is primarily influenced by an individual's internal metabolism and susceptibility to external pathogenic factors. Nevertheless, less is known about whether body constitutions may play a role in the presence of unhealthy lifestyles. We aimed to explore the associations between body constitutions and unhealthy lifestyles among Chinese individuals at high CV risk. METHODS: Computerised data were retrieved from a primary care population-based health record for all 1739 eligible individuals at high CV risk who attended routine check-up in an urbanised, medium-size district in Guangzhou, China. Unhealthy lifestyles were determined in accordance with guideline recommendations. The body constitution was assessed on the basis of physical signs, personality, body symptoms, and the susceptibility to environmental changes, following nationally standard procedure. Binary logistic regression analyses were performed using marginal standardisation method. RESULTS: The participants ranged in age from 20 to 96 years, with a mean age of 69.55 years. There were slightly more females than males (52.3% vs 47.7%). Current smoking, regular drinking, and physical inactivity were most common. Participants with a body constitution of phlegm-and-dampness type (adjusted odds ratio [aOR]=1.999, 95% confidence interval [CI]=1.003-3.984; p=0.049) tended to be current smokers, and those assessed with special diathesis type (aOR=2.166, 95% CI=1.029-4.559; p=0.042) had a higher likelihood of being regular drinkers. Having a body constitution type of blood stasis (aOR=1.375, 95% CI=1.029-1.838; p=0.031) or qi deficient (aOR=1.711, 95% CI=1.080-2.709; p=0.022) was associated with physical inactivity. CONCLUSION: Our findings add to current evidence suggesting that an individual's body constitution is closely related to the presence of unhealthy lifestyles. This offers new insights for health management through body constitution-based strategies to target those at high CV risk who need tailor-made attention in lifestyle modifications during routine primary care.

Mitochondrial genome of Stachyris ruficeps (Aves, Passeriformes, Timaliidae).

Stachyris ruficeps are commonly found in the eastern Himalayas and south China. In our study, we reported the complete mitogenome and obtain basic genetic information of S. ruficeps for the first time. The complete mitochondrial genomes of S. ruficeps (16 885bp in length) had 13 protein-coding genes, 22 tRNA genes, 2 rRNA genes (12S rRNA and 16S rRNA) and 2 control regions. All of the 13 PCGs were initiated by ATG. All the genes in S. ruficeps were distributed on the H-strand, except for the ND6 gene and eight tRNA genes which were encoded on the L-strand.