Speer Elizabeth M, Reddy Sudha, Lommel Tiffany Sellers, Fischer Joan G, Heather Stephens, Park Sohyun, Johnson Mary Ann
Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA.
J Nutr Elder. 2008;27(1-2):179-200. doi: 10.1080/01639360802060298.
A community-based intervention to improve diabetes self-management (DSM) and decrease A1c in older adults with diabetes from Georgia senior centers was evaluated. Participants were a convenience sample that completed the pre-test questionnaire only (N = 351) and a subset that completed the pre-test, intervention, and post-test questionnaires and A1c measurements (n = 144, mean age = 74 years, 84% female, 42% white, 57% black). Incorporating principles of the Health Belief Model and National Standards for DSM, the 4-month intervention consisted of eight sessions focused on improving daily adherence to DSM behaviors and included physical activity. At the post-test, several DSM behaviors increased by > or = 1 day/week: following a healthy eating plan, following an eating plan prescribed by their doctor, eating five or more servings of fruits and vegetables daily, spacing carbohydrates, and inspecting the insides of shoes (P < or = 0.0001). The mean decrease in A1c for the entire sample was 0.25% (SD = 0.82, P < or = 0.001, n = 144) and those with an initial A1c > 8% had a clinically significant mean decrease of 1.15% (SD = 1.09, pre-test: 9.48% vs. 8.33%, P < or = 0.001, n = 24). Increased physical activity was the DSM behavior consistently associated with decreased A1c in regression analyses (P < or = 0.05). The results of this evaluation provide an evidence base for the effectiveness of this community intervention in decreasing A1c and improving DSM behaviors in older adults.
对一项基于社区的干预措施进行了评估，该措施旨在改善佐治亚州老年中心患有糖尿病的老年人的糖尿病自我管理（DSM）并降低糖化血红蛋白（A1c）水平。参与者包括仅完成预测试问卷的便利样本（N = 351），以及完成预测试、干预、后测试问卷和A1c测量的一个子集（n = 144，平均年龄 = 74岁，84%为女性，42%为白人，57%为黑人）。该为期4个月的干预措施纳入了健康信念模型的原则和DSM国家标准，由八个课程组成，重点是提高日常对DSM行为的依从性，并包括体育活动。在后测试中，几种DSM行为每周增加≥1天：遵循健康饮食计划、遵循医生规定的饮食计划、每天食用五份或更多份水果和蔬菜、合理分配碳水化合物以及检查鞋子内部（P≤0.0001）。整个样本的A1c平均下降了0.25%（标准差 = 0.82，P≤0.001，n = 144），初始A1c>8%的人临床显著平均下降了1.15%（标准差 = 1.09，预测试：9.48%对8.33%，P≤0.001，n = 24）。在回归分析中，增加体育活动是与A1c降低始终相关的DSM行为（P≤0.05）。该评估结果为这种社区干预措施在降低老年人A1c水平和改善DSM行为方面的有效性提供了证据基础。
