IMPACT OF THE INNOVATIVE CARE FOR CHRONIC CONDITIONS PROGRAM ON BLOOD SUGAR, BLOOD PRESSURE, LIPID LEVELS, MEDICATION COMPLIANCE AND MENTAL HEALTH AMONG ELDERLY CHINESE WITH HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Hypertension (HT) and type 2 diabetes mellitus (DM) affect the morbidity and mortality of elderly Chinese.  In this study, we aimed to determine the efficacy of the Innovative Care for Chronic Conditions (ICCC) program for improving blood sugar levels, blood pressure levels, lipid levels, medication compliance and mental health among elderly Chinese with HT and DM in order to inform efforts to reduce morbidity and mortality caused by these conditions in the study population.  The ICCC program, administered along with standard pharmacotherapy in the study population (valsartan and metformin), consists of a 6-month program of a supervised low-salt/fat diet, a regular exercise program, daily self-monitoring of blood pressure and blood sugar and psychological support.  The minimum number of subjects calculated to be needed for the study was 322.  Study subjects were recruited from patients with HT and DM admitted to Nanjing First Hospital, China during April 2021-January 2025.  Inclusion criteria for study subjects were: 1) being aged ≥65 years, 2) having diagnoses of HT and DM, 3) living in the study area for at least 6 months, and 4) giving written informed consent to participate in the study.  Exclusion criteria for study subjects were: 1) having severe cardiac, hepatic or renal disease, 2) having a malignant neoplasm, a mental health condition or an active peptic ulcer, 3) being allergic to or intolerant of valsartan and/or metformin, 4) having undergone major surgery in the previous 3 months or 5) having had a serious infection in the previous 3 months.  All patients received standardized pharmacotherapy (valsartan 80-160 mg/day and metformin 1500 mg/day), which is standard pharmacological treatment  in this study population.  Subjects were randomly assigned to either the usual treatment (control) group (n = 161) or the ICCC group (n = 161).  The following were conducted both prior to and after the intervention: blood tests consisting of a fasting blood glucose (FBG) level and lipid profile (consisting of a total cholesterol (TC) level, triglyceride (TG) level, a low density lipoprotein cholesterol (LDL-C) level and a high density lipoprotein cholesterol (HDL-C) level), a blood pressure (BP), a medication compliance assessment (using the Medication Adherence Report Scale (MARS-5) where good compliance was given a score of 5, moderate compliance a score of 3-4 and poor compliance a score of ≤2), a mental health assessment (using the Self-related Anxiety Scale (SAS) and the Self-related Depression Scale (SDS), where the higher the SAS/SDS score the more severe the anxiety/depression) and being asked about treatment adverse reactions with each adverse reaction being counted separately when more than one was present).  A total of 322 subjects were included in the study: 161 in the ICCC (n = 104, 64.6% males) and 161 in the control (n = 97, 60.2% males) group.  The mean (±standard deviation (SD)) ages of study subjects in the ICCC and Control groups were 69 (±3) (range: 65-76) and 69 (±3) (range: 65-74) years, respectively.  Among the ICCC and Control groups after the intervention, the mean (±SD) FPG results were 7.0 (±0.8) and 7.6 (±0.96) mmol/l (p<0.05), the mean (±SD) HbA1c results were 7.1 (±0.6%) and 7.5 (±0.9%) (p<0.05), the mean (±SD) TC levels were 4.6 (±0.6) and 5.0 (±0.7) mmol/l (p<0.05), the mean (±SD) TG levels were 1.5 (±0.4) and 1.6 (±0.3) mmol/l (p<0.05), the mean (±SD) LDL-C levels were 3.0 (±0.7) and 3.6 (±0.8) mmol/l (p<0.05), the mean (±SD) HDL-C levels were 1.3 (±0.2) and 1.1 (±0.2) mmol/l (p<0.05), the mean (±SD) SBP levels were 125.1 (±14.7) and 137.1 (±10.9) mmHg (p<0.001), the mean (±SD) DBP levels were 77 (±9) and 81 (±7) mmHg (p<0.001), the mean (±SD) SAS scores were 25.8 (±4.2) and 30.9 (±5.2) (p<0.001), the mean (±SD) SDS scores were 24.8 (±4.9) and 28.3 (±4.4) (p<0.001), the incidence of adverse reactions were 9.3% and 17.4% (p=0.033), the proportions of subjects with good blood pressure control were 78.9% and 50.3% (p<0.001) and the proportions of subjects with good treatment compliance were 88.2% and 79.5% (p<0.05), respectively.  In summary, the ICCC program was significantly more effective than the usual treatment for lowering blood sugar, lowering blood lipids, lowering blood pressure, improving SAS and SDS scores, improving medication compliance and reducing adverse reactions.  We conclude the ICCC program should be considered for use in the study population to improve outcomes.  Further studies are needed to determine if the results of this study can be applied to other populations in China and if the financial benefits of the ICCC program outweigh the additional costs of the program.