Pouwer F, Snoek F J, van der Ploeg H M, Adèr H J, Heine R J
Department of Medical Psychology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
Diabetes Care. 2001 Nov;24(11):1929-35. doi: 10.2337/diacare.24.11.1929.
To investigate whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient's evaluation of the quality of diabetes care.
This study was a randomized controlled trial of 461 outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition. In the latter group, the diabetes nurse specialist assessed and discussed psychological well-being with the patient (with an interval of 6 months) in addition to standard care. The computerized Well-being Questionnaire was used for this purpose. Primary outcomes were mood, HbA(1c), and the patient's evaluation of the quality of diabetes care at 1-year follow-up. The number of referrals to the psychologist was analyzed as a secondary outcome. Intention-to-treat analysis was used.
The monitoring group reported better mood compared with the standard care group, as indicated by significantly lower negative well-being and significantly higher levels of energy, higher general well-being, better mental health, and a more positive evaluation of the quality of the emotional support received from the diabetes nurse. The two groups did not differ for HbA(1c) or in their overall evaluation of the quality of diabetes care. In the monitoring condition, significantly more subjects were referred to the psychologist.
Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c). Our results support the recommendation to monitor psychological well-being in patients with diabetes.
探讨监测和讨论糖尿病门诊患者的心理健康状况是否能改善其情绪、血糖控制以及患者对糖尿病护理质量的评价。
本研究为一项随机对照试验，纳入461例糖尿病门诊患者，随机分为标准护理组或监测组。在后一组中，糖尿病专科护士除提供标准护理外，还（每隔6个月）对患者的心理健康状况进行评估和讨论。为此使用了计算机化的幸福感问卷。主要结局指标为1年随访时的情绪、糖化血红蛋白（HbA1c）以及患者对糖尿病护理质量的评价。转介至心理医生处的次数作为次要结局指标进行分析。采用意向性分析。
监测组报告的情绪状况优于标准护理组，表现为消极幸福感显著降低、精力水平显著提高、总体幸福感更高、心理健康状况更好，以及对从糖尿病专科护士处获得的情感支持质量评价更为积极。两组在糖化血红蛋白（HbA1c）水平或对糖尿病护理质量的总体评价方面无差异。在监测组中，转介至心理医生处的受试者显著更多。
作为糖尿病门诊常规护理的一部分，监测和讨论心理健康状况对患者情绪有积极影响，但不影响其糖化血红蛋白（HbA1c）水平。我们的结果支持对糖尿病患者进行心理健康监测的建议。
