Anderson Robert M, Funnell Martha M, Aikens James E, Krein Sarah L, Fitzgerald James T, Nwankwo Robin, Tannas Cheryl L, Tang Tricia S
University of Michigan Medical School, Ann Arbor MI.
Ther Patient Educ. 2009 Jun 1;1(1):3-11. doi: 10.1051/tpe/2009002.
This study was conducted to determine if an empowerment-based Diabetes Self-Management Consultant (DSMC) was more effective than a group receiving Mailed metabolic Assessments Only (MAO) in improving diabetes-related quality of life and blood glucose control. MATERIALS AND METHODS: A two-year clinical trial, in which 310 patients with type 2 diabetes were randomized to the DSMC intervention or the MAO group. The DSMC met with the patient to review the baseline assessments, then met with this review was patient and the patient's physician. Subsequently patients received monthly telephone calls from the DSMC who used the empowerment approach to help patients identify self-management problems, consider options, set goals and make adjustments to their diabetes self-management plans. RESULTS: The Diabetes Self-Management Consultant (DSMC) intervention resulted in improvements in diabetes related quality of life (PAID) p= .008, the Empowerment Scale p= .024, A1C p= .016, Perceived understanding of diabetes p= .001 and satisfaction with diabetes care p= .019 as compared to the MAO group. DISCUSSION/CONCLUSION: The DSMC the intervention resulted in a broad array of modest diabetes related improvements. A promising area for future research would be to test the efficacy of combining an empowerment-based DSMC intervention with case management using algorithm-based medication adjustments for higher risk patients.
本研究旨在确定基于赋权的糖尿病自我管理顾问(DSMC)在改善糖尿病相关生活质量和血糖控制方面是否比仅接受邮寄代谢评估(MAO)的组更有效。材料与方法:一项为期两年的临床试验,将310例2型糖尿病患者随机分为DSMC干预组或MAO组。DSMC与患者会面以回顾基线评估,然后与患者及其医生一起回顾。随后,患者每月接到DSMC的电话,DSMC采用赋权方法帮助患者识别自我管理问题、考虑选择、设定目标并调整其糖尿病自我管理计划。结果:与MAO组相比,糖尿病自我管理顾问(DSMC)干预使糖尿病相关生活质量(PAID)得到改善(p = 0.008),赋权量表(p = 0.024)、糖化血红蛋白(A1C)(p = 0.016)、对糖尿病的认知理解(p = 0.001)以及对糖尿病护理的满意度(p = 0.019)均有所改善。讨论/结论:DSMC干预带来了一系列与糖尿病相关的适度改善。未来研究的一个有前景的领域将是测试将基于赋权的DSMC干预与使用基于算法的药物调整的病例管理相结合对高风险患者的疗效。