Bastiaens Hilde, Sunaert Patricia, Wens Johan, Sabbe Bernard, Jenkins Lutgarde, Nobels Frank, Snauwaert Boris, Van Royen Paul
Department of General Practice, Interdisciplinary Healthcare and Geriatrics, University of Antwerp, 2610 Wilrijk, Belgium.
Prim Care Diabetes. 2009 May;3(2):103-9. doi: 10.1016/j.pcd.2009.02.001. Epub 2009 Mar 4.
To develop and implement a group self-management education programme for people with type 2 diabetes at the community level in primary care. This pilot-study intended to evaluate the feasibility, acceptability and long-term effects (12-18 months) of this programme on emotional distress, HbA1c, BMI and actual behaviour.
An empowerment-based, theory-driven education programme was evaluated in a before-after design. The programme focused on behaviour assessment, goal-setting, problem solving and tailored information. A diabetes specialist nurse conjointly with a dietician or psychologist led five 2-hour sessions and a follow-up meeting after 3 months.
Forty-four people participated in 5 groups. BMI decreased with 0.45 kg/m(2) (95%CI 0.01-0.89) at 12-month and with 0.53 kg/m(2) (95%CI 0.02-1.04) at 18-month follow-up. HbA1c declined from 7.4% (+/-1.3) to 6.8% (+/-0.8) (p=0.040) and the PAID-score diminished from 28 (+/-20) to 18 (+/-13) (p=0.006) at 12-month post-intervention. These changes were only partly sustained at 18-month follow-up. Actual behaviour changed modestly.
Introducing the group education programme in primary healthcare is worthwhile (feasibility and effectiveness). A detailed description of the intervention is offered. Further research should explore the actual education process in greater depth.
在基层医疗的社区层面,为2型糖尿病患者制定并实施一项团体自我管理教育计划。这项试点研究旨在评估该计划在情绪困扰、糖化血红蛋白(HbA1c)、体重指数(BMI)及实际行为方面的可行性、可接受性和长期效果(12 - 18个月)。
采用前后对照设计对一项基于赋权、理论驱动的教育计划进行评估。该计划聚焦于行为评估、目标设定、问题解决及个性化信息。一名糖尿病专科护士联合一名营养师或心理学家开展了五次为时2小时的课程,并在3个月后进行了一次随访会议。
44人参与了5个小组。在12个月随访时BMI下降了0.45kg/m²(95%可信区间0.01 - 0.89),在18个月随访时下降了0.53kg/m²(95%可信区间0.02 - 1.04)。干预后12个月时,糖化血红蛋白从7.4%(±1.3)降至6.8%(±0.8)(p = 0.040),糖尿病患者痛苦评估量表(PAID)评分从28(±20)降至18(±13)(p = 0.006)。这些变化在18个月随访时仅部分得以维持。实际行为有适度改变。
在基层医疗中引入团体教育计划是值得的(具有可行性和有效性)。提供了干预措施的详细描述。进一步的研究应更深入地探索实际教育过程。