A Community-Based Comprehensive Intervention Program for 7200 Patients with Type 2 Diabetes Mellitus in Chongqing (China)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Participants
2.2. Intervention
Items | Core Contents | ||
---|---|---|---|
General intervention | Six health lectures, held bimonthly, lasting 1.5 h every time, led by trained general practitioners | Session 1 | Basic knowledge of diabetes |
Session 2 | Risk factors for T2DM | ||
Session 3 | Nutrition and physical activity in T2DM management | ||
Session 4 | How to prevent diabetes-related complications | ||
Session 5 | Management diabetes for life, as foot-care, stress management, fatigue management and usage of insulin | ||
Session 6 | Monitoring diabetes and seeking support from family and friends | ||
Intensive intervention | Individual consultation delivered by general practitioners face to face, every three months, lasting 15 to 20 minutes every time | Pharmacological treatment | Based on China Type 2 Diabetes Guideline (2010) Tips-Emphasize the importance of taking oral medication or insulin in accordance with general practitioner’s prescription. |
Increased physical activity | Goal-At least 150 minutes per week of moderate-intensity aerobic exercise (equivalent to walking). Tips-Engage in physical activity during leisure time and commuting as much as possible; Provide participant with pedometer and encourage them to record the minutes every day. Information leaflets about exercise education were given to all participants. | ||
Dietary modification | Goal-Low in saturated fats (less than 30% of the total fats), increased portions of fiber and vegetables, and maintained an appropriate total calorie intake goal of 1200–1800 kcal per day. Tips-Intake appropriate amounts of fish, eggs, low-fat milk, lean meat; Reduction simple sugars and refined carbohydrates; Increase fiber-rich food, such as whole grains, brown rice, vegetables and fruits. Record food types and portion sizes for one day every three days. Written nutrition education materials were given to all participants. | ||
Weight reduction | Goal-Reduce BMI (body mass index categories) to <24 kg/m2.Tips-Participants were asked to weight themselves once a month. Encourage participants (overweight or obesity) to lose weight by decreasing energy intake and increasing physical activity. | ||
Others | Goals-Smoking cessation (if smoker) and limit alcohol intake (if drinking) to ≤ 2 drinks/day, including 1–2 alcohol-free days/week. Tips-General practitioners emphasized the dangers Of tobacco use and excessive drinking to blood glucose control and provided DVDs to patients. |
2.3. Evaluation
- (a)
- Awareness of T2DM-related knowledge was evaluated using seven questions relating to diagnostic criteria of hypertension and T2DM, typical symptoms, risk factors and main complications of T2DM, and then categorized as known or unknown.
- (b)
- Attitudes towards T2DM, assessed using four questions relating to the cognitive rate of the importance of medication compliance, physical activity and dietary modification, and the positive attitudes towards having diabetes were surveyed and then categorized as “agree” or “disagree”.
- (c)
- Self-care practices: Physical activity modification, dietary modification and medication compliance.
- Physical activity was assessed by Physical activity recall at the last seven days. Participants were classified as adherence or non-adherence which equates to distinguishing between those who achieved at least 150 minutes per week of moderate-intensity aerobic exercise (equivalent to walking) and those who do not [20].
- Dietary nutrient intake was assessed by 24 h recall of the types of food consumed. We calculated energy intake for individual food items with Dietary Guidelines for Chinese Residents [21]. Participants were classified as adherence and non-adherence, which equates to distinguishing between those who achieved the current dietary recommendations and those who do not [20].
- Medication compliance was assessed by use of medical records, and defined as “take oral medication” or “insulin” in accordance with general practitioner’s prescription.
2.4 Statistical Methods
3. Results
3.1. Baseline Characteristics of the Participants
Variables | Total | Urban | Rural |
---|---|---|---|
N | 6586 | 2778 | 3808 |
Gender, n (%) | |||
Male | 2503 (38.0%) | 994 (35.8%) | 1509 (39.6%) |
Female | 4083 (62.0%) | 1784 (64.2%) | 2299 (60.4%) |
Age, n (%) | |||
≤49 years | 718 (10.9%) | 199 (7.2%) | 519 (13.6%) |
50–59 years | 1294 (19.7%) | 579 (20.8%) | 715 (18.8%) |
60–69 years | 2495 (37.9%) | 1040 (37.4%) | 1455 (38.2%) |
70–79 years | 1683 (25.5%) | 766 (27.6%) | 917 (24.1%) |
≥80 years | 396 (6.0%) | 194 (7.0%) | 202 (5.3%) |
Marriage Status, n (%) | |||
Single | 98 (1.5%) | 30 (1.1%) | 68 (1.8%) |
Married | 5750 (87.3%) | 2419 (87.1%) | 3331 (87.5%) |
Widowed | 685 (10.4%) | 291 (10.4%) | 394 (10.3%) |
Divorced | 53 (0.8%) | 38 (1.4%) | 15 (0.4%) |
Ethnics (Han), n (%) | 6157 (93.5%) | 2699 (97.2%) | 3458 (90.8%) |
Education level, n (%) | |||
≤Primary school | 4185 (63.5%) | 1374 (49.5%) | 2811 (73.8%) |
Middle school | 1558 (23.7%) | 834 (30.0%) | 724 (19.0%) |
≥High school | 843 (12.8%) | 570 (20.5%) | 273 (7.2%) |
3.2. Changes of Knowledge, Attitudes and Practices
Variables | Urban (n = 2778) | Rural (n = 3808) | Total (n = 6586) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Rate before (%) | Rate after (%) | x2 | p | Rate before (%) | Rate after (%) | x2 | p | Rate before (%) | Rate after (%) | x2 | p | |
Knowledge | ||||||||||||
Diagnostic criteria for HP | 70.63 | 90.50 | 350.21 | <0.001 | 65.39 | 80.46 | 219.11 | <0.001 | 67.60 | 84.69 | 529.93 | <0.001 |
Diagnostic criteria for T2DM | 63.61 | 78.51 | 150.00 | <0.001 | 50.18 | 84.77 | 1037.75 | <0.001 | 55.85 | 82.13 | 1063.24 | <0.001 |
Typical symptoms for T2DM | 78.94 | 89.99 | 129.29 | <0.001 | 68.43 | 82.12 | 191.50 | <0.001 | 72.87 | 85.44 | 315.42 | <0.001 |
Risk factors of T2DM | ||||||||||||
Lack of physical exercise | 82.04 | 90.19 | 73.08 | <0.001 | 69.56 | 80.05 | 163.73 | <0.001 | 74.83 | 84.33 | 232.99 | <0.001 |
Unhealthy diet | 76.96 | 87.33 | 101.79 | <0.001 | 71.45 | 83.14 | 148.17 | <0.001 | 73.78 | 84.91 | 248.87 | <0.001 |
Smoking | 61.45 | 76.24 | 141.75 | <0.001 | 55.91 | 69.77 | 156.76 | <0.001 | 58.24 | 72.50 | 295.71 | <0.001 |
Main complications of T2DM | 47.34 | 82.43 | 750.95 | <0.001 | 34.56 | 65.76 | 698.24 | <0.001 | 39.95 | 72.80 | 1445.59 | <0.001 |
Attitude | ||||||||||||
Importance of medication compliance | 83.05 | 96.08 | 252.27 | <0.001 | 66.62 | 92.75 | 803.09 | <0.001 | 73.55 | 94.15 | 1032.47 | <0.001 |
Importance of physical activity modification | 51.66 | 87.51 | 843.59 | <0.001 | 45.59 | 75.05 | 690.60 | <0.001 | 48.16 | 80.31 | 1481.01 | <0.001 |
Importance of dietary modification | 72.61 | 86.79 | 172.68 | <0.001 | 62.82 | 81.72 | 339.64 | <0.001 | 66.95 | 83.86 | 507.97 | <0.001 |
T2DM is preventable | 74.44 | 93.77 | 388.29 | <0.001 | 58.11 | 90.78 | 1068.17 | <0.001 | 65.00 | 92.04 | 1427.91 | <0.001 |
Practice | ||||||||||||
Medication compliance | 15.55 | 80.92 | 2377.22 | <0.001 | 22.35 | 71.01 | 1811.36 | <0.001 | 19.48 | 75.19 | 4099.58 | <0.001 |
Physical activity modification | 19.69 | 69.69 | 1404.84 | <0.001 | 18.54 | 66.94 | 2020.99 | <0.001 | 19.02 | 68.10 | 3440.67 | <0.001 |
Dietary modification | 28.08 | 56.19 | 450.28 | <0.001 | 12.00 | 30.99 | 406.75 | <0.001 | 18.78 | 41.62 | 814.66 | <0.001 |
Variables | Primary School or Less (n = 4185) | Middle School (n = 1558) | High School or Above (n = 843) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Rate before (%) | Rate after (%) | x2 | p | Rate before (%) | Rate after (%) | x2 | p | Rate before (%) | Rate after (%) | x2 | p | |
Knowledge | ||||||||||||
Diagnostic criteria for HP | 66.18 | 82.91 | 308.57 | <0.001 | 70.86 | 85.76 | 101.68 | <0.001 | 68.63 | 91.61 | 138.76 | <0.001 |
Diagnostic criteria for T2DM | 54.68 | 82.96 | 779.33 | <0.001 | 57.76 | 82.42 | 225.73 | <0.001 | 58.07 | 77.46 | 72.17 | <0.001 |
Typical symptoms for T2DM | 65.59 | 81.84 | 285.88 | <0.001 | 86.33 | 89.67 | 8.22 | <0.001 | 84.10 | 95.49 | 59.67 | <0.001 |
Risk factors of T2DM | ||||||||||||
Lack of physical exercise | 71.70 | 83.61 | 171.40 | <0.001 | 80.36 | 87.67 | 31.06 | <0.001 | 80.12 | 90.41 | 35.66 | <0.001 |
Unhealthy diet | 71.74 | 84.11 | 186.34 | <0.001 | 76.82 | 85.94 | 42.72 | <0.001 | 78.26 | 86.95 | 22.01 | <0.001 |
Smoking | 57.88 | 72.64 | 201.26 | <0.001 | 59.56 | 71.69 | 50.82 | <0.001 | 57.65 | 73.31 | 45.72 | <0.001 |
Main complications of T2DM | 36.20 | 70.63 | 997.00 | <0.001 | 44.35 | 74.71 | 298.03 | <0.001 | 50.42 | 79.95 | 116.67 | <0.001 |
Attitude | ||||||||||||
Importance of medication compliance | 71.16 | 93.73 | 735.37 | <0.001 | 79.97 | 95.31 | 169.28 | <0.001 | 73.55 | 94.15 | 132.72 | <0.001 |
Importance of physical activity modification | 41.89 | 77.82 | 977.24 | <0.001 | 52.82 | 85.69 | 395.11 | <0.001 | 70.46 | 82.68 | 35.08 | <0.001 |
Importance of dietary modification | 64.43 | 83.54 | 397.21 | <0.001 | 71.82 | 84.79 | 77.08 | <0.001 | 70.46 | 83.74 | 42.15 | <0.001 |
T2DM is preventable | 59.32 | 92.11 | 1224.74 | <0.001 | 71.82 | 90.32 | 173.42 | <0.001 | 80.59 | 94.90 | 80.63 | <0.001 |
Practice | ||||||||||||
Medication compliance | 13.20 | 69.77 | 2759.88 | <0.001 | 20.25 | 80.62 | 1136.77 | <0.001 | 49.23 | 92.05 | 372.70 | <0.001 |
Physical activity modification | 15.87 | 61.51 | 1906.66 | <0.001 | 20.20 | 75.42 | 1063.17 | <0.001 | 32.50 | 87.31 | 678.30 | <0.001 |
Dietary modification | 6.18 | 33.60 | 986.37 | <0.001 | 30.64 | 42.49 | 47.36 | <0.001 | 59.43 | 79.83 | 82.98 | <0.001 |
3.3. Changes of FPG
Area | N | Before (mol/L) | After 1-Year Intervention (mmol/L) | t | p |
---|---|---|---|---|---|
Urban | 2778 | 7.72 ± 2.52 | 6.83 ± 1.19 | 20.66 | <0.001 |
Rural | 3808 | 9.11 ± 2.92 | 7.31 ± 1.40 | 41.05 | <0.001 |
Total | 6586 | 8.53 ± 2.84 | 7.11 ± 1.34 | 44.71 | <0.001 |
Education Level | N | Before (mmol/L) | After 1-Year Intervention (mmol/L) | t | p |
---|---|---|---|---|---|
≤ Primary school | 4185 | 8.82± 2.91 | 7.19 ± 1.39 | 39.41 | <0.001 |
Middle school | 1558 | 8.19 ± 2.74 | 7.03 ± 1.26 | 19.05 | <0.001 |
≥ High school | 843 | 7.68 ± 2.39 | 6.87 ± 1.18 | 11.03 | <0.001 |
Total | 6586 | 8.53 ± 2.84 | 7.11 ± 1.34 | 44.71 | <0.001 |
4. Discussion
5. Conclusions
Acknowledgements
Author Contributions
Conflicts of Interest
References
- Zimmet, P.Z.; Magliano, D.J.; Herman, W.H.; Shaw, J.E. Diabetes: A 21st century challenge. Lancet. Diabetes Endocrinol. 2014, 2, 56–64. [Google Scholar]
- Dall, T.M.; Zhang, Y.; Chen, Y.J.; Quick, W.W.; Yang, W.G.; Fogli, J. The economic burden of diabetes. Health Aff. 2010, 29, 297–303. [Google Scholar]
- Shaw, J.E.; Sicree, R.A.; Zimmet, P.Z. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res. Clin. Pract. 2010, 87, 4–14. [Google Scholar]
- Li, H.; Oldenburg, B.; Chamberlain, C.; O’Neil, A.; Xue, B.; Jolley, D.; Hall, R.; Dong, Z.; Guo, Y. Diabetes prevalence and determinants in adults in China mainland from 2000 to 2010: A systematic review. Diabetes Res. Clin. Pract. 2012, 98, 226–235. [Google Scholar]
- A Mass Survey of Diabetes Mellitus in A Population of 300,000 in 14 Provinces and Municipalities in China (Author’s Transl). Available online: http://www.ncbi.nlm.nih.gov/pubmed/7341098 (accessed on 20 November 1981).
- Xu, Y.; Wang, L.; He, J.; Bi, Y.; Li, M.; Wang, T.; Jiang, Y.; Dai, M.; Lu, J.; Xu, M.; et al. Prevalence and control of diabetes in Chinese adults. JAMA 2013, 310, 948–959. [Google Scholar]
- Mitra, A.; Dewanjee, D.; Dey, B. Mechanistic studies of lifestyle interventions in type 2 diabetes. World J. Diabetes 2012, 3, 201–207. [Google Scholar]
- Umpierre, D.; Ribeiro, P.A.; Kramer, C.K.; Leitao, C.B.; Zucatti, A.T.; Azevedo, M.J.; Gross, J.L.; Ribeiro, J.P.; Schaan, B.D. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis. JAMA 2011, 305, 1790–1799. [Google Scholar]
- Gaede, P.; Lund-Andersen, H.; Parving, H.H.; Pedersen, O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N. Engl. J. Med. 2008, 358, 580–591. [Google Scholar]
- Haas, L.; Maryniuk, M.; Beck, J.; Cox, C.E.; Duker, P.; Edwards, L.; Fisher, E.B.; Hanson, L.; Kent, D.; Kolb, L.; et al. National standards for diabetes self-management education and support. Diabetes Care 2014, 37, S144–S153. [Google Scholar]
- Raz, I.; Riddle, M.C.; Rosenstock, J.; Buse, J.B.; Inzucchi, S.E.; Home, P.D.; Del Prato, S.; Ferrannini, E.; Chan, J.C.; Leiter, L.A.; et al. Personalized management of hyperglycemia in type 2 diabetes: reflections from a diabetes care editors’ expert forum. Diabetes Care 2013, 36, 1779–1788. [Google Scholar]
- Yu, R.; Yan, L.L.; Wang, H.; Ke, L.; Yang, Z.; Gong, E.; Guo, H.; Liu, J.; Gu, Y.; Wu, Y. Effectiveness of a community-based individualized lifestyle intervention among older adults with diabetes and hypertension, Tianjin, China, 2008–2009. Prev. Chronic Dis. 2014, 11. [Google Scholar] [CrossRef]
- Basevi, V.; Di Mario, S.; Morciano, C.; Nonino, F.; Magrini, N. Comment on: American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care 2011; 34 (Suppl. 1): S11–S61. Diabetes Care 2011, 34. [Google Scholar] [CrossRef]
- Grundy, S.M.; Hansen, B.; Smith, S.C., Jr.; Cleeman, J.I.; Kahn, R.A. Clinical management of metabolic syndrome: Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Arterioscler. Thromb. Vasc. Biol. 2004, 24, e19–e24. [Google Scholar]
- Chen, W.; Jiang, H.; Tao, Y.X.; Shu, X.L. [Development and Interpretation of China Medical Nutrition Therapy Guideline for Diabetes (2010)]. Available online: http://www.ncbi.nlm.nih.gov/pubmed/21718605 (accessed on 30 June 2011).
- Gabir, M.M.; Hanson, R.L.; Dabelea, D.; Imperatore, G.; Roumain, J.; Bennett, P.H.; Knowler, W.C. The 1997 American Diabetes Association and 1999 World Health Organization criteria for hyperglycemia in the diagnosis and prediction of diabetes. Diabetes Care 2000, 23, 1108–1112. [Google Scholar]
- Toobert, D.J.; Hampson, S.E.; Glasgow, R.E. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care 2000, 23, 943–950. [Google Scholar]
- Maddison, R.; Ni Mhurchu, C.; Jiang, Y.; Vander Hoorn, S.; Rodgers, A.; Lawes, C.M.; Rush, E. International Physical Activity Questionnaire (IPAQ) and New Zealand Physical Activity Questionnaire (NZPAQ): A doubly labelled water validation. Int. J. Behav. Nutr. Phys. Act. 2007, 4. [Google Scholar] [CrossRef]
- Zhang, Y.; Cao, J.; Chen, W.; Yang, J.; Hao, D.; Chang, P.; Zhao, X. Reproducibility and relative validity of a food frequency questionnaire to assess intake of dietary flavonol and flavone in Chinese university campus population. Nutr. Res. 2010, 30, 520–526. [Google Scholar]
- American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care 2011, 34, S11–S61. [Google Scholar]
- Ge, K. The transition of Chinese dietary guidelines and food guide pagoda. Asia Pac. J. Clin. Nutr. 2011, 20, 439–446. [Google Scholar]
- Kim, S.H.; Lee, S.J.; Kang, E.S.; Kang, S.; Hur, K.Y.; Lee, H.J.; Ahn, C.W.; Cha, B.S.; Yoo, J.S.; Lee, H.C. Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus. Metab. Clin. Exp. 2006, 55, 1053–1059. [Google Scholar]
- Collins, C.; Limone, B.L.; Scholle, J.M.; Coleman, C.I. Effect of pharmacist intervention on glycemic control in diabetes. Diabetes Res. Clin. Pract. 2011, 92, 145–152. [Google Scholar]
- Duke, S.A.; Colagiuri, S.; Colagiuri, R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2009, 1. [Google Scholar] [CrossRef]
- Kamel, N.M.; Badawy, Y.A.; el-Zeiny, N.A.; Merdan, I.A. Sociodemographic determinants of management behaviour of diabetic patients. Part II. Diabetics’ knowledge of the disease and their management behaviour. East. Mediterr. Health J. 1999, 5, 974–983. [Google Scholar]
- Al-Maskari, F.; El-Sadig, M.; Al-Kaabi, J.M.; Afandi, B.; Nagelkerke, N.; Yeatts, K.B. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates. PloS One 2013, 8. [Google Scholar] [CrossRef]
- Al-Adsani, A.M.; Moussa, M.A.; Al-Jasem, L.I.; Abdella, N.A.; Al-Hamad, N.M. The level and determinants of diabetes knowledge in Kuwaiti adults with type 2 diabetes. Diabetes Metab. 2009, 35, 121–128. [Google Scholar]
- Ardena, G.J.; Paz-Pacheco, E.; Jimeno, C.A.; Lantion-Ang, F.L.; Paterno, E.; Juban, N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: Phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes Res. Clin. Pract. 2010, 90, 160–166. [Google Scholar]
- Nilsson, P.M.; Cederholm, J.; Eeg-Olofsson, K.; Eliasson, B.; Zethelius, B.; Fagard, R.; Gudbjornsdottir, S. Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: A report from the Swedish National Diabetes Register. Eur. J. Cardiovasc. Prev. Rehabil. 2009, 16, 506–512. [Google Scholar]
- Morimoto, A.; Ohno, Y.; Tatsumi, Y.; Nishigaki, Y.; Maejima, F.; Mizuno, S.; Watanabe, S. Risk of smoking and body mass index for incidence of diabetes mellitus in a rural Japanese population. Prev. Med. 2012, 54, 341–344. [Google Scholar]
- Zhang, J.; Ou, J.X.; Bai, C.X. Tobacco smoking in China: Prevalence, disease burden, challenges and future strategiey. Respirology 2011, 16, 1165–1172. [Google Scholar]
- Li, Q.; Hsia, J.; Yang, G. Prevalence of smoking in China in 2010. N. Engl. J. Med. 2011, 364, 2469–2470. [Google Scholar]
- Leichter, S.B.; Bowman, K.; Adkins, R.A.; Jelsovsky, Z. Impact of remote management of diabetes via computer: The 360 study—A proof-of-concept randomized trial. Diabetes Technol. Ther. 2013, 15, 434–438. [Google Scholar]
- Shabestari, O.; Roudsari, A. Potential Return on Investment (RoI) on web-based diabetes education in UK. Stud. Health Technol. Inform. 2009, 143, 258–263. [Google Scholar]
- Free, C.; Phillips, G.; Galli, L.; Watson, L.; Felix, L.; Edwards, P.; Patel, V.; Haines, A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med. 2013, 10. [Google Scholar] [CrossRef]
- Williams, E.D.; Bird, D.; Forbes, A.W.; Russell, A.; Ash, S.; Friedman, R.; Scuffham, P.A.; Oldenburg, B. Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management: Baseline findings and six-month outcomes. BMC Public Health 2012, 12. [Google Scholar] [CrossRef] [Green Version]
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Qi, L.; Feng, L.; Tang, W.; Ma, X.; Ding, X.; Mao, D.; Li, J.; Wang, Y.; Xiong, H. A Community-Based Comprehensive Intervention Program for 7200 Patients with Type 2 Diabetes Mellitus in Chongqing (China). Int. J. Environ. Res. Public Health 2014, 11, 11450-11463. https://doi.org/10.3390/ijerph111111450
Qi L, Feng L, Tang W, Ma X, Ding X, Mao D, Li J, Wang Y, Xiong H. A Community-Based Comprehensive Intervention Program for 7200 Patients with Type 2 Diabetes Mellitus in Chongqing (China). International Journal of Environmental Research and Public Health. 2014; 11(11):11450-11463. https://doi.org/10.3390/ijerph111111450
Chicago/Turabian StyleQi, Li, Liangui Feng, Wenge Tang, Xiangyu Ma, Xianbin Ding, Deqiang Mao, Jingxin Li, Yulin Wang, and Hongyan Xiong. 2014. "A Community-Based Comprehensive Intervention Program for 7200 Patients with Type 2 Diabetes Mellitus in Chongqing (China)" International Journal of Environmental Research and Public Health 11, no. 11: 11450-11463. https://doi.org/10.3390/ijerph111111450