Lowe J, Linjawi S, Mensch M, James K, Attia J
Hunter New England Health Service, Newcastle Community Health Centre, 670 Hunter Street, Newcastle, NSW 2303, Australia.
Diabetes Res Clin Pract. 2008 Jun;80(3):439-43. doi: 10.1016/j.diabres.2008.02.003. Epub 2008 Mar 18.
To evaluate the outcomes of an established programme to teach patients to match their insulin dose to their carbohydrate intake.
A prospective observational study in Australia (Newcastle, NSW) of 137 consecutive patients with type 1 (n=82) or type 2 diabetes (n=55) over two successive years. Four educational principles were used to teach intensive insulin management and diabetes self-care skills including: carbohydrate counting and insulin dose adjustment, exercise, appropriate treatment of hypoglycaemia and hyperglycaemia, managing sickness, problem solving, communication with health professionals, goal setting, and the importance of support. Outcomes included changes at 4 and 12 months in HbA1c, self-efficacy measured by a diabetes empowerment scale (DES), diabetes specific quality of life (ADDQoL), and problem solving. Both intention to treat and efficacy analyses were performed.
Diabetes-related quality of life and diabetes problem solving skills improved significantly. Excluding 16 people who failed to adopt intensive insulin management and 24 who started with an HbA1c less than 7%, intention to treat analysis showed the average HbA1c fell from 8.7% initially to 8.1% at 12 months and the number of people with an HbA1c of less than 8% rose from 67 (48.9%) before the program to 86 (62.8%) afterwards.
An intensive diabetes self-management program led to improvements in HbA1c, empowerment, and quality of life that were largely sustained at 1 year. This is all the more remarkable given that the intervention was once only, entailed no long-term follow-up, and took place in normal clinical operations.
评估一项已确立的项目的效果，该项目旨在教导患者使胰岛素剂量与碳水化合物摄入量相匹配。
在澳大利亚新南威尔士州纽卡斯尔进行的一项前瞻性观察性研究，连续两年纳入了137例1型糖尿病患者（n = 82）或2型糖尿病患者（n = 55）。采用四项教育原则来教授强化胰岛素管理和糖尿病自我护理技能，包括：碳水化合物计数和胰岛素剂量调整、运动、低血糖和高血糖的适当治疗、疾病管理、问题解决、与医护人员沟通、目标设定以及支持的重要性。结果包括4个月和12个月时糖化血红蛋白（HbA1c）的变化、通过糖尿病赋权量表（DES）测量的自我效能感、糖尿病特异性生活质量（ADDQoL）以及问题解决能力。进行了意向性分析和疗效分析。
糖尿病相关生活质量和糖尿病问题解决能力显著改善。排除16例未采用强化胰岛素管理的患者以及24例起始糖化血红蛋白低于7%的患者后，意向性分析显示平均糖化血红蛋白从最初的8.7%降至12个月时的8.1%，糖化血红蛋白低于8%的人数从项目开始前的67例（48.9%）增至项目实施后的86例（62.8%）。
一项强化糖尿病自我管理项目使糖化血红蛋白、自我效能感和生活质量得到改善，且在1年时基本维持。鉴于该干预仅进行了一次，没有长期随访，且是在正常临床操作中进行的，这一结果尤为显著。
