Application of dietary management based on behavioral integration theory in CHD and DM patients taking mulberry alkaloids

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However, the cardiovascular risk of patients with coronary heart disease (CHD) complicated with DM who receive total alkaloids of Mulberry branch remains to be studied. Aim: To explore the effect of dietary intervention based on the behavioral integration theory model on the cardiovascular risk of patients with CHD and DM taking total bioactive alkaloids from mulberry branches. Methods: In total, 104 patients with CHD and DM taking total bioactive alkaloids from mulberry branches in our hospital from October 2022 to April 2024 were selected as research subjects. They were randomly divided into the experimental group (n = 52) and the control group (n = 52) based on the random number table method. The control group underwent routine intervention, while the experimental group underwent dietary management intervention based on the behavioral integration theory model, on the basis of the control group. After 6 months, weight, body mass index, waist circumference, waist-hip ratio, total cholesterol, triglycerides, residual cholesterol, fasting blood glucose, 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, and time in range of blood glucose were compared between the two groups. Results: Compared to before the intervention, the weight, body mass index, waist circumference, triglycerides, fasting blood glucose, 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, and time in range of blood glucose of the two groups after the intervention were significantly different ( P < 0.01). Compared to the control group, weight, body mass index, triglycerides, and 2-hour postprandial blood glucose of patients significantly decreased in the experimental group, and the time in range of blood glucose significantly increased ( P < 0.05). Conclusion: Dietary management based on the behavioral integration theory model can improve body shape and decrease triglycerides and blood glucose levels of patients with CHD and DM taking total bioactive alkaloids from mulberry branches, and lower the risk of cardiovascular diseases. Health Belief Model Planned Behavior Theory Diet Ramulus Mori Total Alkaloids CHD DM Introduction Coronary heart disease (CHD), a leading cause of cardiovascular mortality [1], is characterized by high incidence, high disability rate, and high comorbidity rate [2]. Previous studies have found that triglycerides and residual cholesterol can lead to CHD [3-4]. The Expert Consensus on Drug Therapy Management Pathways for Patients with Coronary Atherosclerotic Heart Disease clearly states that DM is an independent risk factor for CHD [5], and the clinical prognosis of patients with CHD and diabetes mellitus (DM) is significantly worse than that of patients with CHD alone [6]. In terms of treatment, acarbose was shown to indirectly affect the fatty acid composition of red blood cell membranes in patients with CHD and DM, and lower the risk of cardiovascular diseases [7-8]. Compared to acarbose, total bioactive alkaloids of mulberry branches, as the first original Chinese patent medicine for DM in China, possess better efficacy and lead to fewer adverse reactions [9-10]. The hypoglycemic mechanism of total bioactive alkaloids of mulberry branches is similar to that of acarbose, both of which delay carbohydrate hydrolysis by selectively inhibiting α-glucosidase activity [11]. Although previous studies have confirmed its hypoglycemic effect, the potential benefits of this drug in patients with CHD and DM have not yet been clarified. Therefore, this study innovatively started from the perspective of dietary management, adopted the behavioral integration theory framework[12], and organically integrated the Health Belief Model [13] (emphasizing individual health cognition) and the Theory of Planned Behavior [14], which covers multiple factors, such as attitude, subjective norms, and perceived behavioral control, thereby constructing a systematic dietary management plan. Through scientific laboratory indicators, this study explored the effects of this intervention model on the body shape, blood lipids, and blood glucose levels of patients with CHD and DM who take total bioactive alkaloids from mulberry branches, providing new ideas for modifying cardiovascular disease risk in clinical practice. Materials and Methods Participants Patients with CHD and DM who orally received the total bioactive alkaloids of mulberry branches in our hospital from October 2022 to April 2024 were selected as research subjects. Triglycerides were the main observation index. We considered two-sided α= 0.05 and β= 0.1 as the test levels. The mean triglyceride levels in the control group and the experimental group after intervention in the pilot study were 1.56 and 1.89, respectively, with standard deviations of 0.39 and 0.51. Using PASS 15 software and considering a 20% dropout rate, a total of 104 cases were determined to be necessary for this study. The inclusion criteria were as follows: 1) voluntary participation and signing the informed consent form; 2) having the diagnosis of CHD based on the "Guidelines for the Diagnosis and Treatment of Chronic Stable Angina Pectoris" formulated by the Cardiovascular Disease Branch of the Chinese Medical Association [15], and type 2 DM based on the "Chinese Guidelines for the Prevention and Treatment of Type 2 DM" released by the DM Branch of the Chinese Medical Association in 2020 [16]; and 3) patients with CHD and type 2 DM, aged 18-75 years, and orally receiving total bioactive alkaloids of mulberry branches. The exclusion criteria were as follows: 1) liver and kidney dysfunction, with alanine aminotransferase values exceeding 2.5 times the upper limit of normal and serum creatinine exceeding 1.3 times the upper limit of normal; 2) repeated urinary tract infections; 3) history of drug abuse or alcohol dependence in the past 5 years; 4) use of systemic hormones or drugs in the past 3 months affecting cholesterol levels; 5) infection/stress within 4 weeks before participation; 6) pregnancy, lactation, or pregnancy intention; 7) other severe conditions or comorbidities, such as severe neurological and pancreatic diseases, cancer, etc.; 8) non-compliance with the dietary management intervention plan. Control group The control group underwent conventional dietary intervention, including regular offline dietary education sessions held weekly. In addition, simulated real-life types of dietary intake were used to teach about the types and quantities of food intake. The food exchange portion model, as the most widely applied model in dietary management [17], was adopted by the nutritionist to develop recommended recipes (with strict quantitative carbohydrate intake). It was uniformly distributed after each education session. Experimental group Establishing a dietary management intervention group for patients with CHD and DM who orally take total alkaloids from the mulberry branch The intervention team consisted of one associate chief physician from the cardiology department, one associate chief physician from the endocrinology department, two head nurses, six specialized nurses, one nutritionist, and two postgraduate students with master’s degrees. The associate chief physician comprehensively assessed the patient's physical condition. The head nurses revised and implemented the dietary management plan, and were responsible for the overall arrangement and quality control. The specialized nurses were responsible for the implementation of the plan; the nutritionist was responsible for the adjustment of the plan and the education; the researcher himself formulated the plan, and the 2 postgraduate students collected and analyzed data. In the experimental group, a dietary management plan based on the behavioral integration theory model was developed (1) Introduction of the behavioral integration theory model: This model integrates the health belief model and the theory of planned behavior, fully leveraging the advantages of both and enhancing the explanatory power of behavior [18]. It analyzes the factors affecting patients' diet management by measuring 8 variables: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, behavioral attitude, subjective norms, perceived behavioral control, and behavioral intention. By perceiving the threat of the disease, it helps patients strengthen their belief regarding diet management and maintain the diet management behavior. (2) Specific contents of the dietary management intervention plan: This study was designed based on the behavioral integration theory model, and referred to "Adult DM Diet and Nutrition Guidelines (2023 Edition) [19]" and "Chinese Residents' Dietary Guidelines (2022) [20]". Through systematic search and refinement, we extracted relevant items on dietary management for patients with CHD and DM from both Chinese and international sources, forming the initial draft of the dietary management plan. We consulted with nutrition experts, integrated their opinions, and finally prepared the final draft of the dietary management plan based on the behavioral integration theory model (Table 1). Implementation of dietary management intervention based on the behavioral integration theory model The experimental group received the intervention based on the control group. The intervention content included 4 sessions: ① perceived susceptibility and perceived severity (the first session), through various forms, such as offline, online, and scenario simulation, to establish correct dietary beliefs and correct incorrect dietary behaviors; ② perceived benefits and perceived obstacles (the second session) from the perspectives of oneself and fellow patients to understand dietary management, using a combination of interviews and questionnaires (quantitative and qualitative) to comprehensively understand dietary management obstacles; ③ behavioral attitude, subjective norms, and perceived behavioral control (the third session) from one's own attitude, social support and related factors to maintain dietary management behaviors; and ④ behavioral intention (the fourth session) to consolidate and strengthen the third session and dietary management. Each session was conducted every 3 weeks, each lasting approximately 90 minutes. The duration of intervention was the same in the experimental and control groups, and the intervention locations did not touch each other to prevent contamination. Evaluation index The main indicators were as follows: triglyceride (TG), residual cholesterol (RC), fasting plasma glucose (FPG), 1-hour postprandial glucose (1hPG), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), and time in range (TIR) of glucose. Secondary indicators were as follows: weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and total cholesterol (TC). Data collection Before the intervention, the two postgraduate students with master’s degrees collected information of the research subjects, including their gender, age, hypertension, duration of CHD combined with DM, height, weight, BMI, WC, hip circumference (HC), WHR, TC, and TG. After the intervention, the researchers collected data on body weight, BMI, WC, HC, WHR, TC, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, TG, and HbA1c through follow-up records and test reports. RC was obtained by calculating the difference between total cholesterol and high-density lipoprotein cholesterol. FPG, 1hPG, and 2hPG were collected through the oral glucose tolerance test, and TIR was collected using the scanning glucose monitoring system. Statistical analysis Data were analyzed using SPSS 25.0 (IBM Corp, Armonk, NY, USA). Normally distributed data are expressed as ±s, and within-group comparisons were made using paired sample t-tests. Between-group comparisons were made using two independent sample t-tests. RC data exhibited a skewed distribution and are represented as M (P25, P75). Within-group comparisons were made using the Wilcoxon signed-rank test, and between-group comparisons were conducted using the Mann-Whitney U test. Categorical data are expressed as (n, %), and between-group comparisons were conducted using the chi-square test. A difference was considered statistically significant when P < 0.05. Results Baseline characteristics Among the 104 patients, 53 were male and 51 were female. There were no significant differences between the two groups in terms of gender, age, hypertension, duration of CHD combined with DM, height ( P > 0.05) (Table 2 ). Table 1 The specific content of the dietary management plan based on the behavioral integration theory model Variables Goal Concrete Content Perceived susceptibility Set up correct diet faith, delay complications development process ① Offline PPT teaching explains the dietary structure, principles, types, and quantities for patients with CHD and DM who take oral total alkaloids from mulberry branches. It also emphasizes the need for a standardized diet and the importance of dietary management. ② The diet seminar presents dietary tips through a combination of real objects and pictures, clearly explaining dietary calories and exchange portions. ③ Prize-based guessing games and heuristic questioning help patients solve their problems, and friendly competition motivates patients' enthusiasm. ④ Video education, establishing a WeChat official account, uploading dietary education videos, and consolidating and deepening patients' beliefs in healthy dietary management. Perceived severity Correct eating behavior, and reduce the risk of complications ① Look for error points, orally present negative examples, and point out the incorrect behaviors. ② Self-sharing: encouraging patients to share their own eating habits and conduct self-inspections and self-corrections; ③ Scenario simulation, simulating real-life situations, guiding patients to assume roles, setting up incorrect eating behaviors, and observing patients' reactions. Perceived benefits Explain diet management benefits and encourage adherence to the diet management behavior ① Online registration. Guide patients with CHD and DM who orally take total alkaloids from the mulberry branch to keep a diary of their diet, weight, waist circumference, hip circumference, and changes in blood sugar. Take photos and upload them to the WeChat group for registration weekly, set an achievement baseline based on individual conditions, praise those who reach the standard, and determine why some of them do not reach the standard while strengthening the educational efforts; ② Patient sharing: Patients with better dietary management should be invited to engage in offline and online exchanges and sharing. The exemplary power of these patients motivates other patients to adhere to the dietary management behavior. Disturbance of perception Understand the causes of dietary management disorders and help get rid of them ① Offline interviews and face-to-face interviews to understand the causes and related factors that make diet management difficult for patients and provide targeted treatment; ② Questionnaire distribution: Distribute the questionnaire regarding the obstacles in the face of dietary management, thereby providing targeted measures and overcoming dietary management obstacles. Behavioral attitude Love food management, adhere to the diet management behavior ① Self-narrative, through a period of dietary management supplemented by a management diary, expresses views on dietary management behavior, and can help understand the patient's attitude toward dietary management behavior. Subjective norm Supporting with the aid of family members, relatives and friends to promote adherence to the diet management behavior ① Conduct online and offline lectures on dietary management behaviors for the patients' family members and friends, emphasizing the necessity of such behaviors and reminding them to supervise the patients to enhance adherence to the dietary management plan; ② Social support involves mobilizing the efforts of family members, friends, colleagues and other people around the patients, encouraging the patients and assisting them in maintaining their dietary management behaviors. Perceptual behavioral control Strengthening the management of diet benefits and eliminating diet management block ① Unscheduled video-based science popularization, answering questions, presenting real cases through video format, emphasizing the importance of diet management, setting questions for answering, and consolidating dietary knowledge; ② Regular follow-ups are needed, either in person or via phone calls, to assess the patient's feelings regarding dietary management. For those patients who are non-compliant with the diet or have poor feelings about it, the reasons should be identified, and obstacles should be removed to strengthen the dietary management behaviors. Behavioral intention Reaching an intention on dietary management behavior and adhering to it The specific content of behavioral intention is a combination of behavioral attitude, subjective norms, and perceived behavioral control [ 21 ] (please refer to the relevant positions in Table 1 for details) Table 2 Comparison of general information between the two groups Variables Experimental group (n = 52) Control group (n = 52) Statistic P Gender, n(%) χ 2 = 0.038 0.844 Male 26(50) 27(51.92) Female 26(50) 25(48.08) Age(years) 60.94 ± 7.51 60.25 ± 9.04 t = 0.425 0.672 Hypertension, n (%) 34(65.38) 36(69.23) χ 2 = 0.175 0.676 Duration of CHD combined with DM(years) 8.58 ± 2.67 8.48 ± 2.70 t = 0.183 0.855 Height(m) 1.63 ± 0.06 1.64 ± 0.08 t= -1.196 0.235 1) χ 2 : Chi-square test; 2) t ༚ t -test Comparison of body type, blood lipid, and blood glucose indicators between the two groups after intervention Compared to before the intervention, body weight, BMI, WC, TG, FPG, 1hPG, 2hPG, HbA1c of the two groups significantly decreased after the intervention and TIR significantly increased ( P < 0.01)(Table 3 ). Body weight, BMI, TG, and 2hPG of the experimental group were significantly lower than those of the control group, and the TIR was significantly higher than that of the control group ( P < 0.05). Table 3 Comparison of body size, blood lipid, and blood glucose levels between the two groups after the intervention Variables Before Intervention Statistic P After Intervention Statistic P Experimental group(n = 52) Control group(n = 52) Experimental group(n = 52) Control group(n = 52) Weight(kg) 66.76 ± 9.33 69.44 ± 7.48 t= -1.618 0.109 59.79 ± 7.93 * 66.88 ± 8.53 * t= -4.395 <0.001 BMI(kg/m 2 ) 25.19 ± 3.01 25.84 ± 3.26 t= -1.047 0.298 22.59 ± 2.80 * 24.85 ± 3.40 * t= -3.699 <0.001 WC(cm) 91.42 ± 9.23 90.79 ± 8.53 t = 0.364 0.716 88.50 ± 10.25 * 88.38 ± 9.08 * t = 0.061 0.952 WHR 0.94 ± 0.13 0.92 ± 0.11 t = 0.826 0.411 0.91 ± 0.14 * 0.91 ± 0.11 t = 0.031 0.975 TC(mmol/L) 5.21 ± 0.29 5.38 ± 1.38 t= -0.900 0.370 5.14 ± 0.82 5.14 ± 1.15 # t=- 0.040 0.968 TG(mmol/L) 2.21 ± 0.65 2.25 ± 0.06 t= -0.342 0.733 1.93 ± 0.33 * 2.22 ± 0.04 * t= -6.343 <0.001 RC(mmol/L) 1.68(1.24,2.13) 1.57(1.02,3.23) Z= -0.852 0.394 1.25(0.55,1.99) # 1.58(0.82,2.32) Z= -1.213 0.225 FPG(mmol/L) 8.59 ± 1.74 9.00 ± 1.93 t= -1.108 0.270 8.07 ± 1.81 * 8.33 ± 2.14 * t=- 0.666 0.507 1Hpg(mmol/L) 15.11 ± 2.85 15.54 ± 2.57 t= -0.808 0.421 14.46 ± 2.31 * 14.21 ± 2.69 * t = 0.506 0.614 2Hpg(mmol/L) 15.85 ± 2.87 16.21 ± 3.22 t= -0.602 0.549 13.61 ± 3.44 * 14.97 ± 1.97 * t= -2.460 0.016 HbA1c(%) 8.12 ± 0.56 8.09 ± 0.50 t = 0.370 0.712 7.37 ± 0.93 * 7.68 ± 1.01 * t= -1.601 0.113 TIR(%) 67.40 ± 13.58 63.71 ± 9.62 t = 1.600 0.113 74.29 ± 12.12 * 67.85 ± 8.48 * t = 3.141 0.002 1) t : t-test;2) Z ༚Mann-Whitney U test༛3) Compared to before the intervention, * P <0.01, # P <0.05 Discussion Dietary management based on the behavioral integration theory model can effectively improve the body weight, BMI, and WC of patients This study showed that compared to before the intervention, the body weight, BMI, and WC of patients in both groups significantly decreased after the intervention ( P < 0.01). This finding suggests that both conventional dietary intervention and the new dietary management intervention based on the behavioral integration theory model can effectively improve weight-related indicators of patients with CHD and DM. This finding is consistent with the viewpoint of R Gallagher [ 22 ] regarding the importance of dietary intervention in the management of metabolic diseases. Due to insignificant changes in patients' height during the study period, the improvement in BMI was mainly attributed to weight loss. Moreover, both intervention methods optimized and adjusted the types of diet based on the disease characteristics of CHD and DM, which is consistent with the findings of previous studies [ 23 ] on the effect of diet types on WC. Thus, it explains the significant improvement in WC. Further analysis revealed that the improvement in the weight and BMI of the experimental group after the intervention was significantly better than that of the control group ( P < 0.05). This difference is consistent with the findings of H Dambha-Miller et al. [ 24 ] on the effect of intensive dietary intervention and may be due to the advantages of the new adherence intervention model. First, it uses dietary salons and other measures to strengthen patients' awareness of disease-specific diets. Second, it employs different measures, such as management diaries to know patients' attitudes toward diet management. Finally, it combines digital means, such as online check-ins and questionnaires, to achieve real-time feedback, forming a complete self-management closed-loop system and promoting the formation of dietary management behaviors. Dietary management intervention based on the behavioral integration theory model can lower TG and RC levels This study showed that after the intervention, the triglyceride (TG) levels of both groups of patients showed a downward trend, and the improvement in the experimental group was much greater than that in the control group ( P < 0.05). This finding indicates that although both conventional and new interventions can effectively improve lipid metabolism in patients with CHD and DM, the new intervention scheme based on the behavioral integration theory model offers greater therapeutic advantages. Available evidence suggests that dietary components are closely associated with TG levels [ 25 ]. From the perspective of pathophysiological mechanisms, the elevated levels of free fatty acids in the hypertriglyceridemia state can impair glucose-stimulated insulin secretion. Under the synergistic effect of oxidative stress, endoplasmic reticulum stress, and pro-apoptotic signaling pathways, this metabolic abnormality may exacerbate the dysfunction and apoptosis of pancreatic β cells, thereby increasing the risk of DM and cardiovascular diseases [ 26 ]. Both groups of patients received individualized dietary plans formulated by professional nutritionists based on the metabolic characteristics of CHD and DM, using the food exchange portion method to precisely calculate the intake of various nutrients, and strictly controlling the ratios of carbohydrates, fats, and proteins. This scientific nutritional intervention approach improved TG levels in both groups of patients. The significant advantage of the experimental group may originate from its innovative dietary management model. Based on the behavioral integration theory model, the new model systematically affects psychological cognitive factors, such as patients' disease perception, health attitude, and behavioral intention, effectively stimulating and maintaining dietary management behaviors. Long-term adherence to a scientific diet is significantly and positively correlated with blood sugar and lipid control [ 27 ], which explains why the experimental group achieved excellent intervention results. From a clinical perspective, strengthening dietary management not only delays the progression of diabetic complications but also significantly lowers the risk of cardiovascular events (directly manifested as RC closer to the normal value), thereby improving the quality of life and long-term prognosis of patients. Dietary management based on the behavioral integration theory model can reduce 2hPG levels and extend the TIR Our results showed that after the intervention, the levels of FPG, 1hPG, 2hPG, HbA1c, and TIR in both groups were significantly lower than those before the intervention ( P < 0.01), suggesting that the conventional intervention and the new intervention both effectively improved the blood glucose control of patients with CHD and DM. It is worth noting that the 2hPG levels of both groups decreased significantly after the intervention, with a greater reduction in the experimental group than in the control group ( P < 0.05). This finding is consistent with the results of Feng YQ et al. [ 28 ]. Compared to the conventional intervention, the new adherence intervention adopted in this study offers the following advantages: Firstly, it integrates the health belief model and the theory of planned behavior in the theoretical framework. It also comprehensively assesses patients' cognition regarding disease susceptibility and severity, as well as the benefits and obstacles related to behavior change. Moreover, it considers external influencing factors, such as social support, to comprehensively improve the effect of dietary management behavior. Secondly, the implementation method integrates online and offline education models, using video teaching, virtual simulation technology, online check-in, and other digital means supporting real-time blood glucose monitoring and timely intervention. This closed-loop management model can help promptly detect latent hyperglycemia and provide feedback for adjusting treatment, thereby standardizing blood glucose management. 2hPG, as the main diagnostic threshold for DM proposed by the American DM Association and the World Health Organization [ 29 ], reflects not only the accuracy of blood sugar control but is also closely related to the risk of cardiovascular diseases.The results of this study indicate that the improvement effect of the new intervention program on this key indicator is significantly better than that of the conventional intervention. In this study, TIR of both groups significantly increased after the intervention (Table 3 ), with a greater improvement in the experimental group than in the control group ( P < 0.05). This result confirms that compared to the conventional intervention, the new intervention scheme can offer significantly greater improvement in key indicators. The objective data of the real-time glucose monitoring system strongly support this conclusion. Limitations Due to the single-center research design (implemented only in a tertiary hospital) and the relatively limited sample size, the universality of the research results needs further verification. Conclusions The dietary management intervention study based on the behavioral integration theory model systematically influences the health perception, dietary attitude and behavioral intention of patients with CHD and DM, effectively stimulating the motivation for dietary behavior change in patients, correcting the attitude towards dietary management, and strengthening long-term dietary management behaviors. This study found that this theory-driven intervention strategy has significant clinical value in improving patients' body fat indicators, blood sugar control and overall health outcomes. Declarations Clinical Trial Registration ClinicalTrials.gov, NCT05856578 Financial Disclosure Key Project of the Health Commission of Nanjing City, Jiangsu Province(ZKX22038). Ethics approval and consent to participate The studies involving human participants were reviewed and approved by the Institutional Review Board (or Ethics Committee) of Nanjing First Hospital, Nanjing Medical University(KY20220124-03). All participants were assigned written informed consent before data collection. Consent for publication The authors declare that the participants gave written informed consent for their personal or clinical details along with any identifying images to be ublished in this study. Competing interests The authors declare no competing interests. Author Contribution L.Y designed and refined the entire study. L.Y and H.F entered, integrated, analyzed, and wrote the entire article. J M.Q and Y.C were responsible for the clinical study. 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Front Endocrinol (Lausanne). 2018;9:384. 10.3389/fendo.2018.00384 . Vetrani C, Verde L, Colao A et al. The Mediterranean Diet: Effects on Insulin Resistance and Secretion in Individuals with Overweight or Obesity. Nutrients. 2023;15(21):4524. Published 2023 Oct 25. 10.3390/nu15214524 Feng YQ, Hu TY, Zhao HM, et al. The application of the integrated online and offline health education model in patients with gestational diabetes. Nurs Res. 2023;37(16):3037–40. Sweeting A, Hare MJ, de Jersey SJ et al. Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes. Med J Aust Published online June 22. 10.5694/mja2.52696 Additional Declarations No competing interests reported. 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Previous studies have found that triglycerides and residual cholesterol can lead to CHD [3-4]. The Expert Consensus on Drug Therapy Management Pathways for Patients with Coronary Atherosclerotic Heart Disease clearly states that DM is an independent risk factor for CHD [5], and the clinical prognosis of patients with CHD and diabetes mellitus (DM) is significantly worse than that of patients with CHD alone [6]. In terms of treatment, acarbose was shown to indirectly affect the fatty acid composition of red blood cell membranes in patients with CHD and DM, and lower the risk of cardiovascular diseases [7-8]. Compared to acarbose, total bioactive alkaloids of mulberry branches, as the first original Chinese patent medicine for DM in China, possess better efficacy and lead to fewer adverse reactions [9-10]. The hypoglycemic mechanism of total bioactive alkaloids of mulberry branches is similar to that of acarbose, both of which delay carbohydrate hydrolysis by selectively inhibiting α-glucosidase activity [11]. Although previous studies have confirmed its hypoglycemic effect, the potential benefits of this drug in patients with CHD and DM have not yet been clarified. Therefore, this study innovatively started from the perspective of dietary management, adopted the behavioral integration theory framework[12], and organically integrated the Health Belief Model [13] (emphasizing individual health cognition) and the Theory of Planned Behavior [14], which covers multiple factors, such as attitude, subjective norms, and perceived behavioral control, thereby constructing a systematic dietary management plan. Through scientific laboratory indicators, this study explored the effects of this intervention model on the body shape, blood lipids, and blood glucose levels of patients with CHD and DM who take total bioactive alkaloids from mulberry branches, providing new ideas for modifying cardiovascular disease risk in clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with CHD and DM who orally received the total bioactive alkaloids of mulberry branches in our hospital from October 2022 to April 2024 were selected as research subjects. Triglycerides were the main observation index. We considered two-sided α= 0.05 and β= 0.1 as the test levels. The mean triglyceride levels in the control group and the experimental group after intervention in the pilot study were 1.56 and 1.89, respectively, with standard deviations of 0.39 and 0.51. Using PASS 15 software and considering a 20% dropout rate, a total of 104 cases were determined to be necessary for this study.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: 1) voluntary participation and signing the informed consent form; 2) having the diagnosis of CHD based on the \"Guidelines for the Diagnosis and Treatment of Chronic Stable Angina Pectoris\" formulated by the Cardiovascular Disease Branch of the Chinese Medical Association [15], and type 2 DM based on the \"Chinese Guidelines for the Prevention and Treatment of Type 2 DM\" released by the DM Branch of the Chinese Medical Association in 2020 [16]; and 3) patients with CHD and type 2 DM, aged 18-75 years, and orally receiving total bioactive alkaloids of mulberry branches. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were as follows: 1) liver and kidney dysfunction, with alanine aminotransferase values exceeding 2.5 times the upper limit of normal and serum creatinine exceeding 1.3 times the upper limit of normal; 2) repeated urinary tract infections; 3) history of drug abuse or alcohol dependence in the past 5 years; 4) use of systemic hormones or drugs in the past 3 months affecting cholesterol levels; 5) infection/stress within 4 weeks before participation; 6) pregnancy, lactation, or pregnancy intention; 7) other severe conditions or comorbidities, such as severe neurological and pancreatic diseases, cancer, etc.; 8) non-compliance with the dietary management intervention plan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Control group\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe control group underwent conventional dietary intervention, including regular offline dietary education sessions held weekly. In addition, simulated real-life types of dietary intake were used to teach about the types and quantities of food intake. The food exchange portion model, as the most widely applied model in dietary management [17], was adopted by the nutritionist to develop recommended recipes (with strict quantitative carbohydrate intake). It was uniformly distributed after each education session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental group\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEstablishing a dietary management intervention group for patients with CHD and DM who orally take total alkaloids from the mulberry branch\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention team consisted of one associate chief physician from the cardiology department, one associate chief physician from the endocrinology department, two head nurses, six specialized nurses, one nutritionist, and two postgraduate students with master’s degrees. The associate chief physician comprehensively assessed the patient's physical condition. The head nurses revised and implemented the dietary management plan, and were responsible for the overall arrangement and quality control. The specialized nurses were responsible for the implementation of the plan; the nutritionist was responsible for the adjustment of the plan and the education; the researcher himself formulated the plan, and the 2 postgraduate students collected and analyzed data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn the experimental group, a dietary management plan based on the behavioral integration theory model was developed\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Introduction of the behavioral integration theory model: This model integrates the health belief model and the theory of planned behavior, fully leveraging the advantages of both and enhancing the explanatory power of behavior [18]. It analyzes the factors affecting patients' diet management by measuring 8 variables: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, behavioral attitude, subjective norms, perceived behavioral control, and behavioral intention. By perceiving the threat of the disease, it helps patients strengthen their belief regarding diet management and maintain the diet management behavior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2)\u0026nbsp;\u003c/strong\u003eSpecific contents of the dietary management intervention plan: This study was designed based on the behavioral integration theory model, and referred to \"Adult DM Diet and Nutrition Guidelines (2023 Edition) [19]\" and \"Chinese Residents' Dietary Guidelines (2022) [20]\". Through systematic search and refinement, we extracted relevant items on dietary management for patients with CHD and DM from both Chinese and international sources, forming the initial draft of the dietary management plan. We consulted with nutrition experts, integrated their opinions, and finally prepared the final draft of the dietary management plan based on the behavioral integration theory model (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation of dietary management intervention based on the behavioral integration theory model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental group received the intervention based on the control group. The intervention content included 4 sessions: ① perceived susceptibility and perceived severity (the first session), through various forms, such as offline, online, and scenario simulation, to establish correct dietary beliefs and correct incorrect dietary behaviors; ② perceived benefits and perceived obstacles (the second session) from the perspectives of oneself and fellow patients to understand dietary management, using a combination of interviews and questionnaires (quantitative and qualitative) to comprehensively understand dietary management obstacles; ③ behavioral attitude, subjective norms, and perceived behavioral control (the third session) from one's own attitude, social support and related factors to maintain dietary management behaviors; and ④ behavioral intention (the fourth session) to consolidate and strengthen the third session and dietary management. Each session was conducted every 3 weeks, each lasting approximately 90 minutes.\u003c/p\u003e\n\u003cp\u003eThe duration of intervention was the same in the experimental and control groups, and the intervention locations did not touch each other to prevent contamination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation index\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main indicators were as follows: triglyceride (TG), residual cholesterol (RC), fasting plasma glucose (FPG), 1-hour postprandial glucose (1hPG), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), and time in range (TIR) of glucose.\u003c/p\u003e\n\u003cp\u003eSecondary indicators were as follows: weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and total cholesterol (TC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore the intervention, the two postgraduate students with master’s degrees collected information of the research subjects, including their gender, age, hypertension, duration of CHD combined with DM, height, weight, BMI, WC, hip circumference (HC), WHR, TC, and TG. After the intervention, the researchers collected data on body weight, BMI, WC, HC, WHR, TC, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, TG, and HbA1c through follow-up records and test reports. RC was obtained by calculating the difference between total cholesterol and high-density lipoprotein cholesterol. FPG, 1hPG, and 2hPG were collected through the oral glucose tolerance test, and TIR was collected using the scanning glucose monitoring system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 25.0 (IBM Corp, Armonk, NY, USA). Normally distributed data are expressed as \u003cem\u003e\u003cimg width=\"13\" height=\"21\" src=\"data:image/wmf;base64,R0lGODlhFAAgAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMABQAOABcAhAAAAAAAAAAAHR0AAAAAMwAdMgAcSB0zWgAzWh1IWx1GbDMAADQdNDNbgEgcAEgdHVozHVozAF1dRl1/f0huf2xGHW5bNX9/XXtqRGZ3d2aIiIBbM4iIZgECAwECAwECAwVCICCOZBmcaHqWbOu+cCzPdG3bDkqM504GAtLiwKoEDCOFKxJAAIivnDM2CMIYgIGv9eAhWRATuFAaBEjMgG+T2oUAADs=\" alt=\"image\"\u003e\u003c/em\u003e±s, and within-group comparisons were made using paired sample t-tests. Between-group comparisons were made using two independent sample t-tests. RC data exhibited a skewed distribution and are represented as M (P25, P75). Within-group comparisons were made using the Wilcoxon signed-rank test, and between-group comparisons were conducted using the Mann-Whitney U test. Categorical data are expressed as (n, %), and between-group comparisons were conducted using the chi-square test. A difference was considered statistically significant when \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n \u003ch2\u003eBaseline characteristics\u003c/h2\u003e\n \u003cp\u003eAmong the 104 patients, 53 were male and 51 were female. There were no significant differences between the two groups in terms of gender, age, hypertension, duration of CHD combined with DM, height (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThe specific content of the dietary management plan based on the behavioral integration theory model\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGoal\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eConcrete Content\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePerceived susceptibility\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSet up correct diet faith, delay complications development process\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Offline PPT teaching explains the dietary structure, principles, types, and quantities for patients with CHD and DM who take oral total alkaloids from mulberry branches. It also emphasizes the need for a standardized diet and the importance of dietary management. ② The diet seminar presents dietary tips through a combination of real objects and pictures, clearly explaining dietary calories and exchange portions. ③ Prize-based guessing games and heuristic questioning help patients solve their problems, and friendly competition motivates patients\u0026apos; enthusiasm. ④ Video education, establishing a WeChat official account, uploading dietary education videos, and consolidating and deepening patients\u0026apos; beliefs in healthy dietary management.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePerceived severity\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCorrect eating behavior, and reduce the risk of complications\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Look for error points, orally present negative examples, and point out the incorrect behaviors. ② Self-sharing: encouraging patients to share their own eating habits and conduct self-inspections and self-corrections; ③ Scenario simulation, simulating real-life situations, guiding patients to assume roles, setting up incorrect eating behaviors, and observing patients\u0026apos; reactions.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePerceived benefits\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eExplain diet management benefits and encourage adherence to the diet management behavior\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Online registration. Guide patients with CHD and DM who orally take total alkaloids from the mulberry branch to keep a diary of their diet, weight, waist circumference, hip circumference, and changes in blood sugar. Take photos and upload them to the WeChat group for registration weekly, set an achievement baseline based on individual conditions, praise those who reach the standard, and determine why some of them do not reach the standard while strengthening the educational efforts; ② Patient sharing: Patients with better dietary management should be invited to engage in offline and online exchanges and sharing. The exemplary power of these patients motivates other patients to adhere to the dietary management behavior.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDisturbance of perception\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUnderstand the causes of dietary management disorders and help get rid of them\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Offline interviews and face-to-face interviews to understand the causes and related factors that make diet management difficult for patients and provide targeted treatment; ② Questionnaire distribution: Distribute the questionnaire regarding the obstacles in the face of dietary management, thereby providing targeted measures and overcoming dietary management obstacles.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBehavioral attitude\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLove food management, adhere to the diet management behavior\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Self-narrative, through a period of dietary management supplemented by a management diary, expresses views on dietary management behavior, and can help understand the patient\u0026apos;s attitude toward dietary management behavior.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSubjective norm\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSupporting with the aid of family members, relatives and friends to promote adherence to the diet management behavior\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Conduct online and offline lectures on dietary management behaviors for the patients\u0026apos; family members and friends, emphasizing the necessity of such behaviors and reminding them to supervise the patients to enhance adherence to the dietary management plan; ② Social support involves mobilizing the efforts of family members, friends, colleagues and other people around the patients, encouraging the patients and assisting them in maintaining their dietary management behaviors.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePerceptual behavioral control\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStrengthening the management of diet benefits and eliminating diet management block\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e① Unscheduled video-based science popularization, answering questions, presenting real cases through video format, emphasizing the importance of diet management, setting questions for answering, and consolidating dietary knowledge; ② Regular follow-ups are needed, either in person or via phone calls, to assess the patient\u0026apos;s feelings regarding dietary management. For those patients who are non-compliant with the diet or have poor feelings about it, the reasons should be identified, and obstacles should be removed to strengthen the dietary management behaviors.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBehavioral intention\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReaching an intention on dietary management behavior and adhering to it\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThe specific content of behavioral intention is a combination of behavioral attitude, subjective norms, and perceived behavioral control [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e] (please refer to the relevant positions in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for details)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\u003cbr\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of general information between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(51.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(48.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.94\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(65.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of CHD combined with DM(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight(m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-1.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e1) \u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e: Chi-square test; 2) \u003cem\u003et\u003c/em\u003e༚\u003cem\u003et\u003c/em\u003e-test\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eComparison of body type, blood lipid, and blood glucose indicators between the two groups after intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCompared to before the intervention, body weight, BMI, WC, TG, FPG, 1hPG, 2hPG, HbA1c of the two groups significantly decreased after the intervention and TIR significantly increased (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01)(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Body weight, BMI, TG, and 2hPG of the experimental group were significantly lower than those of the control group, and the TIR was significantly higher than that of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of body size, blood lipid, and blood glucose levels between the two groups after the intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBefore Intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAfter Intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.76\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-1.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.79\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-4.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-1.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-3.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWC(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.25\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTC(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=-\u003c/em\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTG(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-6.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRC(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.68(1.24,2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.57(1.02,3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e-0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25(0.55,1.99)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58(0.82,2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e-1.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFPG(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-1.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=-\u003c/em\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1Hpg(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2Hpg(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-2.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHbA1c(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et=\u003c/em\u003e-1.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTIR(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.40\u0026thinsp;\u0026plusmn;\u0026thinsp;13.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.71\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.12\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;3.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e1) \u003cem\u003et\u003c/em\u003e: t-test;2) \u003cem\u003eZ\u003c/em\u003e༚Mann-Whitney U test༛3) Compared to before the intervention, \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eDietary management based on the behavioral integration theory model can effectively improve the body weight, BMI, and WC of patients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that compared to before the intervention, the body weight, BMI, and WC of patients in both groups significantly decreased after the intervention (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This finding suggests that both conventional dietary intervention and the new dietary management intervention based on the behavioral integration theory model can effectively improve weight-related indicators of patients with CHD and DM. This finding is consistent with the viewpoint of R Gallagher [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e] regarding the importance of dietary intervention in the management of metabolic diseases. Due to insignificant changes in patients' height during the study period, the improvement in BMI was mainly attributed to weight loss. Moreover, both intervention methods optimized and adjusted the types of diet based on the disease characteristics of CHD and DM, which is consistent with the findings of previous studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e] on the effect of diet types on WC. Thus, it explains the significant improvement in WC. Further analysis revealed that the improvement in the weight and BMI of the experimental group after the intervention was significantly better than that of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This difference is consistent with the findings of H Dambha-Miller et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e] on the effect of intensive dietary intervention and may be due to the advantages of the new adherence intervention model. First, it uses dietary salons and other measures to strengthen patients' awareness of disease-specific diets. Second, it employs different measures, such as management diaries to know patients' attitudes toward diet management. Finally, it combines digital means, such as online check-ins and questionnaires, to achieve real-time feedback, forming a complete self-management closed-loop system and promoting the formation of dietary management behaviors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDietary management intervention based on the behavioral integration theory model can lower TG and RC levels\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that after the intervention, the triglyceride (TG) levels of both groups of patients showed a downward trend, and the improvement in the experimental group was much greater than that in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This finding indicates that although both conventional and new interventions can effectively improve lipid metabolism in patients with CHD and DM, the new intervention scheme based on the behavioral integration theory model offers greater therapeutic advantages. Available evidence suggests that dietary components are closely associated with TG levels [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. From the perspective of pathophysiological mechanisms, the elevated levels of free fatty acids in the hypertriglyceridemia state can impair glucose-stimulated insulin secretion. Under the synergistic effect of oxidative stress, endoplasmic reticulum stress, and pro-apoptotic signaling pathways, this metabolic abnormality may exacerbate the dysfunction and apoptosis of pancreatic β cells, thereby increasing the risk of DM and cardiovascular diseases [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Both groups of patients received individualized dietary plans formulated by professional nutritionists based on the metabolic characteristics of CHD and DM, using the food exchange portion method to precisely calculate the intake of various nutrients, and strictly controlling the ratios of carbohydrates, fats, and proteins. This scientific nutritional intervention approach improved TG levels in both groups of patients. The significant advantage of the experimental group may originate from its innovative dietary management model. Based on the behavioral integration theory model, the new model systematically affects psychological cognitive factors, such as patients' disease perception, health attitude, and behavioral intention, effectively stimulating and maintaining dietary management behaviors. Long-term adherence to a scientific diet is significantly and positively correlated with blood sugar and lipid control [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which explains why the experimental group achieved excellent intervention results. From a clinical perspective, strengthening dietary management not only delays the progression of diabetic complications but also significantly lowers the risk of cardiovascular events (directly manifested as RC closer to the normal value), thereby improving the quality of life and long-term prognosis of patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDietary management based on the behavioral integration theory model can reduce 2hPG levels and extend the TIR\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur results showed that after the intervention, the levels of FPG, 1hPG, 2hPG, HbA1c, and TIR in both groups were significantly lower than those before the intervention (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), suggesting that the conventional intervention and the new intervention both effectively improved the blood glucose control of patients with CHD and DM. It is worth noting that the 2hPG levels of both groups decreased significantly after the intervention, with a greater reduction in the experimental group than in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This finding is consistent with the results of Feng YQ et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Compared to the conventional intervention, the new adherence intervention adopted in this study offers the following advantages: Firstly, it integrates the health belief model and the theory of planned behavior in the theoretical framework. It also comprehensively assesses patients' cognition regarding disease susceptibility and severity, as well as the benefits and obstacles related to behavior change. Moreover, it considers external influencing factors, such as social support, to comprehensively improve the effect of dietary management behavior. Secondly, the implementation method integrates online and offline education models, using video teaching, virtual simulation technology, online check-in, and other digital means supporting real-time blood glucose monitoring and timely intervention. This closed-loop management model can help promptly detect latent hyperglycemia and provide feedback for adjusting treatment, thereby standardizing blood glucose management. 2hPG, as the main diagnostic threshold for DM proposed by the American DM Association and the World Health Organization [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e], reflects not only the accuracy of blood sugar control but is also closely related to the risk of cardiovascular diseases.The results of this study indicate that the improvement effect of the new intervention program on this key indicator is significantly better than that of the conventional intervention. In this study, TIR of both groups significantly increased after the intervention (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), with a greater improvement in the experimental group than in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result confirms that compared to the conventional intervention, the new intervention scheme can offer significantly greater improvement in key indicators. The objective data of the real-time glucose monitoring system strongly support this conclusion.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eDue to the single-center research design (implemented only in a tertiary hospital) and the relatively limited sample size, the universality of the research results needs further verification.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe dietary management intervention study based on the behavioral integration theory model systematically influences the health perception, dietary attitude and behavioral intention of patients with CHD and DM, effectively stimulating the motivation for dietary behavior change in patients, correcting the attitude towards dietary management, and strengthening long-term dietary management behaviors. This study found that this theory-driven intervention strategy has significant clinical value in improving patients' body fat indicators, blood sugar control and overall health outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eClinical Trial Registration\u003c/h2\u003e\u003cp\u003eClinicalTrials.gov, NCT05856578\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eFinancial Disclosure\u003c/h2\u003e\u003cp\u003eKey Project of the Health Commission of Nanjing City, Jiangsu Province(ZKX22038).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003e The studies involving human participants were reviewed and approved by the Institutional Review Board (or Ethics Committee) of Nanjing First Hospital, Nanjing Medical University(KY20220124-03). All participants were assigned written informed consent before data collection.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e The authors declare that the participants gave written informed consent for their personal or clinical details along with any identifying images to be ublished in this study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.Y designed and refined the entire study. L.Y and H.F entered, integrated, analyzed, and wrote the entire article. J M.Q and Y.C were responsible for the clinical study. H Q.L and Q.L offered constructive suggestions for the article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank the patients and their families and all colleagues and EditSprings (https://www.editsprings.cn ) who contributed to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the first author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUS Preventive Services Task Force, Mangione CM, Barry MJ, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. 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Med J Aust Published online June 22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5694/mja2.52696\u003c/span\u003e\u003cspan address=\"10.5694/mja2.52696\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Belief Model, Planned Behavior Theory, Diet, Ramulus Mori Total Alkaloids, CHD, DM","lastPublishedDoi":"10.21203/rs.3.rs-7358012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7358012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTotal alkaloids of Mulberry branch, as China's first traditional Chinese patent medicine for diabetes mellitus (DM), act via a pharmacological mechanism similar to acarbose, with few adverse reactions, controllable quality, and significant hypoglycemic effects. However, the cardiovascular risk of patients with coronary heart disease (CHD) complicated with DM who receive total alkaloids of Mulberry branch remains to be studied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo explore the effect of dietary intervention based on the behavioral integration theory model on the cardiovascular risk of patients with CHD and DM taking total bioactive alkaloids from mulberry branches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn total, 104 patients with CHD and DM taking total bioactive alkaloids from mulberry branches in our hospital from October 2022 to April 2024 were selected as research subjects. They were randomly divided into the experimental group (n = 52) and the control group (n = 52) based on the random number table method. The control group underwent routine intervention, while the experimental group underwent dietary management intervention based on the behavioral integration theory model, on the basis of the control group. After 6 months, weight, body mass index, waist circumference, waist-hip ratio, total cholesterol, triglycerides, residual cholesterol, fasting blood glucose, 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, and time in range of blood glucose were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eCompared to before the intervention, the weight, body mass index, waist circumference, triglycerides, fasting blood glucose, 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, and time in range of blood glucose of the two groups after the intervention were significantly different (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.01). Compared to the control group, weight, body mass index, triglycerides, and 2-hour postprandial blood glucose of patients significantly decreased in the experimental group, and the time in range of blood glucose significantly increased (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Dietary management based on the behavioral integration theory model can improve body shape and decrease triglycerides and blood glucose levels of patients with CHD and DM taking total bioactive alkaloids from mulberry branches, and lower the risk of cardiovascular diseases.\u003c/p\u003e","manuscriptTitle":"Application of dietary management based on behavioral integration theory in CHD and DM patients taking mulberry alkaloids","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 07:13:22","doi":"10.21203/rs.3.rs-7358012/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-06T09:20:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-21T08:51:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T13:01:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46788750988410832762351243307582857311","date":"2025-10-25T18:50:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T15:51:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T08:53:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284748505640664323344135608055610251178","date":"2025-10-17T17:16:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309365671312735519021743184064516407185","date":"2025-10-17T14:29:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268835858831498593918458736191874946101","date":"2025-10-17T13:29:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-16T08:08:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188495783036838163547781500623043313259","date":"2025-10-15T03:29:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149960145623740507281081203914642870430","date":"2025-10-11T09:44:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268856286700265313491125058753852733215","date":"2025-10-11T05:30:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T17:53:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-15T06:27:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-05T07:41:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T14:49:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-09-04T14:35:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5be06a16-b9cf-4e19-b31c-3fd50fe2cb75","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-06T09:20:59+00:00","index":76,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T07:13:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 07:13:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7358012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7358012","identity":"rs-7358012","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}