Trento M, Basile M, Borgo E, Grassi G, Scuntero P, Trinetta A, Cavallo F, Porta M
Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy.
J Endocrinol Invest. 2008 Nov;31(11):1038-42. doi: 10.1007/BF03345645.
To verify if Group Care, a model to manage Type 2 diabetes (T2DM) by systemic continuing group education, can be administered by nurses and dieticians under pedagogic guidance, and improve metabolic control, quality of life, Locus of Control, and insulin resistance.
Twenty-five patients with non-insulin-treated T2DM were randomized to Group Care and 24 to continued habitual individual care and education delivered by a diabetes specialist and pedagogist, respectively. Six nurses and 1 dietician received training by an accredited programme, a detailed operating manual and pedagogical supervision throughout the study. Follow-up was for 2 yr and included measurements of fasting blood glucose, glycated hemoglobin (HbA1c), body mass index, waist circumference, lipids, creatinine, blood pressure, serum insulin, homeostasis model assessment (HOMA) index of insulin resistance, health behaviors, quality of life, state and trait anxiety, and Locus of Control.
One patient on Group Care and 3 controls dropped out. At the end of study, the patients on Group Care had lower HbA1c (7.6+/-0.8 vs 8.4+/-1.3, p<0.05), insulin (18.0+/-9.6 vs 24.3+/-13.7, p<0.001), HOMA index (6.9+/-5.4 vs 9.2+/-6.6, p<0.05), and fatalistic attitude (17.2+/-5.9 vs 24.9+/-4.2, p<0.001) and better quality of life (65.0+/-11.0 vs 78.4+/-19.6, p<0.001) than controls.
Group Care delivered by trained nurses and dietitian is associated with better outcomes than those obtained by a medically and pedagogically qualified team. It may offer a model for health operators to re-organize clinical practice and for patients to improve lifestyle and strengthen the therapeutic alliance with their carers.
验证“团体照护”这一通过系统性持续团体教育来管理2型糖尿病（T2DM）的模式，能否在教育学指导下由护士和营养师实施，并改善代谢控制、生活质量、控制源和胰岛素抵抗。
25例非胰岛素治疗的T2DM患者被随机分为“团体照护”组，24例被分到继续接受由糖尿病专科医生和教育学家提供的常规个体护理和教育组。在整个研究过程中，6名护士和1名营养师接受了经认可的培训项目、一份详细的操作手册以及教育学监督。随访为期2年，包括测量空腹血糖、糖化血红蛋白（HbA1c）、体重指数、腰围、血脂、肌酐、血压、血清胰岛素、胰岛素抵抗的稳态模型评估（HOMA）指数、健康行为、生活质量、状态焦虑和特质焦虑以及控制源。
“团体照护 ”组有1例患者退出，对照组有3例退出。研究结束时，“团体照护 ”组患者的HbA1c（7.6±0.8 vs 8.4±1.3，p<0.05）、胰岛素（18.0±9.6 vs 24.3±13.7，p<0.001）、HOMA指数（6.9±5.4 vs 9.2±6.6，p<0.05）和宿命论态度（17.2±5.9 vs 24.9±4.2，p<0.001）均低于对照组，生活质量（65.0±11.0 vs 78.4±19.6，p<0.001）则优于对照组。
由经过培训的护士和营养师提供的“团体照护 ”比由医学和教育学资质团队获得更好的效果。它可能为健康从业者重新组织临床实践以及为患者改善生活方式和加强与护理人员的治疗联盟提供一种模式。
