University of Newcastle and Hunter New England Health Service, NSW, Australia.
Diabet Med. 2009 Dec;26(12):1277-81. doi: 10.1111/j.1464-5491.2009.02858.x.
To show that an advanced diabetes education programme delivers sustained benefits to people with diabetes prescribed insulin and healthcare providers over and above those provided by basic diabetes education.
An historical cohort study of 68 people with Type 1 and 51 people with Type 2 diabetes on insulin who attended the 4-day Newcastle Empowerment programme in 2001 and 2002 compared with 71 people with Type 1 and 312 people with Type 2 diabetes who attended only the basic 4-day insulin education programme over the same period, followed until 2007. Primary outcome was all hospital admissions and emergency visits; secondary outcomes were the composite of first cardiac event or death and readmission for diabetes complications. Cox-proportional hazards regression was used to analyse Type 1 and Type 2 diabetes separately.
The empowerment programme significantly delayed time to first hospital admission/visit for patients with Type 2 diabetes; the hazard ratio (HR) of 0.41 (P = 0.01) translates into a delay of almost 3 years; this was partly driven by a significant reduction in cardiovascular events and mortality (HR = 0.24, P = 0.01). These effects were not seen for people with Type 1 diabetes.
A one-time, advanced diabetes education programme teaching intensive insulin self-management with an empowerment style can lead to sustained improvement in patient outcomes and reduce use of hospital services for people with Type 2 diabetes on insulin.
展示强化糖尿病教育方案为使用胰岛素治疗的 1 型和 2 型糖尿病患者及其医护人员带来的益处，优于基础糖尿病教育。
对 2001 年和 2002 年参加为期 4 天的纽卡斯尔增能方案的 68 名 1 型和 51 名 2 型糖尿病患者（接受胰岛素治疗）以及同期仅参加基本 4 天胰岛素教育方案的 71 名 1 型和 312 名 2 型糖尿病患者进行历史队列研究，随访至 2007 年。主要结局是所有住院和急诊就诊；次要结局是首次心脏事件或死亡及因糖尿病并发症再次入院的复合结局。采用 Cox 比例风险回归分别分析 1 型和 2 型糖尿病。
增能方案显著延迟了 2 型糖尿病患者首次住院/就诊时间；2 型糖尿病患者的风险比（HR）为 0.41（P=0.01），这意味着延迟了近 3 年；这部分归因于心血管事件和死亡率的显著降低（HR=0.24，P=0.01）。这一效果在 1 型糖尿病患者中未观察到。
一次性的、强化的糖尿病教育方案，教授强化胰岛素自我管理并采用增能模式，可使接受胰岛素治疗的 2 型糖尿病患者的患者结局持续改善，并减少对医院服务的利用。
