代谢控制、患者教育及胰岛素治疗起始对2型糖尿病患者生活质量的影响。
Effects of metabolic control, patient education and initiation of insulin therapy on the quality of life of patients with type 2 diabetes mellitus.
作者信息
Braun Anke, Sämann Alexander, Kubiak Thomas, Zieschang Tania, Kloos Christof, Müller Ulrich Alfons, Oster Peter, Wolf Gunter, Schiel Ralf
机构信息
Bethanien Hospital, Department of Geriatrics at the University of Heidelberg, Heidelberg, Germany.
出版信息
Patient Educ Couns. 2008 Oct;73(1):50-9. doi: 10.1016/j.pec.2008.05.005. Epub 2008 Jun 25.
OBJECTIVE
The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus.
METHODS
This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbA1c 10.1+/-1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-index 28.7+/-5.7 kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles.
RESULTS
Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p=0.03), fewer physical complaints (p=0.03), fewer worries about the future (p=0.02), fewer daily struggles (p=0.01) and less fear of hypoglycaemia (p<0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control.
CONCLUSIONS
Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus.
PRACTICE IMPLICATIONS
Appropriate interventions resulting in better metabolic control, such as starting on insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life.
目的
本研究的目的是评估胰岛素治疗的起始、代谢控制及系统性患者教育对接受胰岛素治疗的2型糖尿病患者糖尿病相关生活质量（QoL）的影响。
方法
本前瞻性研究纳入了大学医院连续招募的71例接受胰岛素治疗的糖尿病患者。所有患者均参加了住院糖尿病治疗与教学项目（DTTP）以接受常规胰岛素治疗（平均年龄68.9岁，糖化血红蛋白10.1±1.4%，糖尿病病程11.2年（范围：0 - 25.5年），体重指数28.7±5.7kg/m²）。在参加DTTP之前及之后6个月，使用Lohr标准化问卷分析子量表（社会关系、身体不适、对未来的担忧、饮食限制、低血糖恐惧及日常困扰）来评估糖尿病相关生活质量。
结果
仅开始胰岛素治疗的患者在参加DTTP 6个月后糖尿病相关生活质量有显著改善（p = 0.03），身体不适减少（p = 0.03），对未来的担忧减少（p = 0.02），日常困扰减少（p = 0.01），低血糖恐惧减轻（p < 0.001），而已经接受胰岛素治疗的患者糖尿病相关生活质量无改善。不过，残差分析显示对患者生活质量的影响主要由代谢控制的改善引起。
结论
代谢控制的改善对糖尿病患者不同的糖尿病相关生活质量领域有显著影响。
实践意义
采取适当干预措施以实现更好的代谢控制，如在系统性患者教育项目中开始胰岛素治疗，似乎是改善患者糖尿病相关生活质量的有效方法。
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