Zoffmann Vibeke, Lauritzen Torsten
Institute of Public Health, Department of Nursing Science, University of Aarhus, Denmark.
Patient Educ Couns. 2006 Dec;64(1-3):78-86. doi: 10.1016/j.pec.2005.11.017. Epub 2006 May 23.
To report 1-year results of newly developed method, guided self-determination (GSD), applied in group training (GSD-GT) for Type 1 diabetes patients with persistent poor glycaemic control.
GSD was designed on the basis of qualitative research to help patients develop life skills with diabetes using worksheets filled in at home and coached by nurses in mutual reflection. We randomized 18-49-year-old adults at a Danish university hospital to either 16 h GSD-GT in 2001 or to similar training 1 year later.
mean A1C> or =8.0% for at least 2 years, disease onset < or =40 years and insulin treatment from onset.
Thirty GSD-GT patients and 20 controls completed the study. GSD-GT patients did better than control patients in terms of (a) increased autonomy support perceived from health professionals (p<0.01); (b) higher frequency of self-monitored blood glucoses (p<0.001); (c) increased perceived competence in managing diabetes (p<0.01); (d) fewer diabetes-related problems (p<0.05); and (e) improved glycaemic control (p<0.01).
GSD was effective in improving life skills with diabetes, including A1C, over a period of 1 year.
GSD is a worthy candidate for further research. We consider it adjustable to people with type 2 diabetes and other chronic conditions.
报告一种新开发的方法——引导式自主决策（GSD）在1型糖尿病血糖控制持续不佳患者的团体训练（GSD-GT）中的1年效果。
GSD基于定性研究设计，通过患者在家填写工作表并由护士指导进行相互反思，帮助患者培养糖尿病生活技能。我们将丹麦一家大学医院18 - 49岁的成年人随机分为两组，一组在2001年接受16小时的GSD-GT训练，另一组在1年后接受类似训练。
至少2年平均糖化血红蛋白（A1C）≥8.0%，发病年龄≤40岁且自发病起接受胰岛素治疗。
30名GSD-GT患者和20名对照组患者完成了研究。GSD-GT组患者在以下方面表现优于对照组患者：（a）从医护人员那里感受到的自主支持增加（p<0.01）；（b）自我监测血糖的频率更高（p<0.001）；（c）糖尿病管理方面的自我效能感增强（p<0.01）；（d）糖尿病相关问题更少（p<0.05）；（e）血糖控制改善（p<0.01）。
在1年的时间里，GSD在改善糖尿病生活技能（包括糖化血红蛋白）方面是有效的。
GSD是值得进一步研究的对象。我们认为它适用于2型糖尿病患者和其他慢性病患者。
