Integrated Lifestyle Management in Patients with Type 2 Diabetes Mellitus: A Retrospective Propensity Score-matched Cohort Study

Summary

Multidisciplinary team-based lifestyle management was associated with improved self-management, glycemic control, nutritional status, psychological well-being, screening adherence, and satisfaction, as well as a lower observed rate of newly documented complications over 12 months.

Abstract

This retrospective propensity score-matched cohort study examined the associations of multidisciplinary team (MDT)-based integrated lifestyle management with glycemic, psychological, behavioral, nutritional, and screening-related outcomes in patients with type 2 diabetes mellitus (T2DM). Clinical data were collected from 133 hospitalized patients with T2DM between June 1, 2024, and December 31, 2024. After 1:1 nearest-neighbor propensity score matching (PSM), 130 patients were included: 65 in the MDT-based management group and 65 in the conventional management group. The primary outcome was the change in glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary exploratory outcomes included fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), Self-Rating Depression Scale (SDS) score, Self-Rating Anxiety Scale (SAS) score, Summary of Diabetes Self-Care Activities (SDSCA) score, health literacy, nutritional protein indicators, complication screening, newly documented chronic complications, adherence, and satisfaction. At 12 months, the MDT-based management group showed a greater reduction in HbA1c than the conventional management group. The MDT-based management group was also associated with lower FPG, 2hPG, SDS, and SAS scores; higher SDSCA and health literacy scores; more favorable albumin, prealbumin, transferrin, and retinol-binding protein levels; higher complication-screening completion rates; greater adherence and satisfaction; and a lower observed rate of newly documented chronic complications. In this single-center cohort of hospitalized patients with T2DM, MDT-based integrated lifestyle management was associated with more favorable multidimensional outcomes during 12 months of observational follow-up. Because of the retrospective matched-cohort design, these findings should be interpreted as observational associations in the studied inpatient population rather than as evidence of causality.

Introduction

According to the International Diabetes Federation Diabetes Atlas, approximately 463 million adults were living with diabetes worldwide in 2019. Among adults aged 18 years and older, the prevalence reached 11.2%, and the total number of affected individuals exceeded 140 million¹. At present, the global challenge of preventing and controlling type 2 diabetes mellitus (T2DM) remains substantial. According to data reported using the American Diabetes Association diagnostic criteria, the awareness rate of T2DM is only 36.5%, the treatment rate is 32.2%, and the rate of adequate glycemic control is below 49.2%; approximately 1.4 million people die e....

Protocol

The study was approved by the Medical Ethics Committee of the Fourth Affiliated Hospital of Soochow University (No. 2025-251264), which approved a waiver of informed consent because anonymized routine clinical data were used. The research tools used for this protocol are listed in the Table of Materials.

1. Study design

This study used a retrospective propensity score-matching (PSM) cohort design. Clinical data were extracted from the electronic medical record (EMR) system for patients with T2DM who were hospitalized in the Department of Endocrinology of our hospital between June 1....

Results

Baseline characteristics of the study population
The derivation of the matched analytic cohort and follow-up denominators is shown in Table 2. After 1:1 nearest-neighbor propensity score matching, 130 patients were included, comprising 65 patients in the observation group and 65 patients in the conventional group. Following matching, most baseline variables were well balanced between groups, and no statistically significant differences were observed in baseline characteristics (P >.......

Discussion

Using a retrospective propensity score-matched cohort design, this study systematically evaluated the associations of MDT-based lifestyle management with multiple clinical outcomes in patients with T2DM. Compared with traditional routine management, MDT-based integrated lifestyle management was associated with more favorable changes in negative emotions, self-management ability, glycemic control, nutritional status, complication-screening adherence, and newly documented chronic complications. Within this single-center in.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automatic biochemical analyzer	Hitachi High-Technologies Corporation, Tokyo, Japan	Hitachi 7600 automatic biochemical analyzer	Used to measure fasting plasma glucose, 2-hour postprandial glucose, albumin, prealbumin, transferrin, and retinol-binding protein.
Bedside blood glucose meter	Roche Diabetes Care GmbH, Mannheim, Germany	Accu-Chek Guide Me blood glucose meter	Used for bedside fasting and 2-hour postprandial fingertip blood glucose monitoring during hospitalization.
Biochemical assay reagents	Hitachi High-Technologies Corporation / compatible original reagent system	Hitachi 7600-compatible original reagents	Used with the automatic biochemical analyzer for routine biochemical detection of glucose and nutritional protein indicators.
China Food Composition Tables	Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention; Peking University Medical Press	Standard Edition, 6th edition, Volume 1; ISBN 978-7-5659-1699-1	Used to estimate daily high-quality protein intake and the proportion of animal versus plant protein intake from 3-day dietary recalls.
China Food Composition Tables	Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention; Peking University Medical Press	Standard Edition, 6th edition, Volume 2; ISBN 978-7-5659-1978-7	Used as an additional food composition reference for dietary intake estimation.
Chinese Health Literacy Scale Short-Form	Chinese validated version of the HLS-SF12	HLS-SF12, 12-item Chinese version	Used to assess health literacy across healthcare, disease prevention, and health promotion domains.
HbA1c analyzer	Bio-Rad Laboratories, Hercules, CA, USA	VARIANT II Hemoglobin Testing System	Used for HbA1c measurement by high-performance liquid chromatography.
HbA1c reagent system	Bio-Rad Laboratories, Hercules, CA, USA	VARIANT II TURBO HbA1c Kit 2.0, Cat. No. 12000447	Reagent system compatible with the Bio-Rad VARIANT II platform for HbA1c testing.
Lifestyle intervention adherence scale	Self-designed by the study team	Self-designed lifestyle adherence scale	Used to assess adherence to diet, exercise, follow-up, and lifestyle management tasks.
Mini-Mental State Examination	Standard cognitive screening scale	MMSE, 30-point cognitive screening scale	Used during eligibility screening to exclude patients with cognitive impairment.
Morisky Medication Adherence Scale	Morisky Medication Adherence Research LLC / standard adherence scale	Morisky Medication Adherence Scale	Used to assess medication adherence and classify adherence into complete, partial, and non-adherence categories.
Self-Rating Anxiety Scale	Standard clinical scale developed by W. W. K. Zung	SAS, 20-item self-report scale	Used to assess anxiety symptoms; higher scores indicate more severe anxiety status.
Self-Rating Depression Scale	Standard clinical scale developed by W. W. K. Zung	SDS, 20-item self-report scale	Used to assess depressive symptoms; higher scores indicate more severe depressive status.
Statistical analysis software	IBM Corp., Armonk, NY, USA	IBM SPSS Statistics, Version 26.0	Used for propensity score matching, descriptive statistics, group comparisons, repeated-measures analysis, and sensitivity analyses.
Summary of Diabetes Self-Care Activities	Standard diabetes self-management scale	SDSCA, 11-item scale	Used to assess diabetes self-care behaviors across diet, exercise, blood glucose monitoring, medication adherence, and foot care.
T2DM management satisfaction questionnaire	Self-designed by the study team	Self-designed satisfaction questionnaire; Cronbach’s α=0.89	Used to evaluate patient satisfaction across medical services, health education, and psychological support.