The Duke Integrative Medicine, Duke University Medical Center, Durham, North Carolina (Dr Wolever, Mr Dreusicke, Dr Fikkan, Ms Hawkins, Ms Yeung, Ms Wakefield, Ms Duda)
Health Management Innovations, GlaxoSmithKline, Research Triangle Park, North Carolina (Ms Flowers, Dr Cook, Dr Skinner)
Diabetes Educ. 2010 Jul-Aug;36(4):629-39. doi: 10.1177/0145721710371523. Epub 2010 Jun 9.
The purpose of this study was to evaluate the effectiveness of integrative health (IH) coaching on psychosocial factors, behavior change, and glycemic control in patients with type 2 diabetes.
Fifty-six patients with type 2 diabetes were randomized to either 6 months of IH coaching or usual care (control group). Coaching was conducted by telephone for fourteen 30-minute sessions. Patients were guided in creating an individualized vision of health, and goals were self-chosen to align with personal values. The coaching agenda, discussion topics, and goals were those of the patient, not the provider. Preintervention and postintervention assessments measured medication adherence, exercise frequency, patient engagement, psychosocial variables, and A1C.
Perceived barriers to medication adherence decreased, while patient activation, perceived social support, and benefit finding all increased in the IH coaching group compared with those in the control group. Improvements in the coaching group alone were also observed for self-reported adherence, exercise frequency, stress, and perceived health status. Coaching participants with elevated baseline A1C (>/=7%) significantly reduced their A1C.
A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs. Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy, accountability, and clinical outcomes.
本研究旨在评估综合健康（IH）辅导对 2 型糖尿病患者心理社会因素、行为改变和血糖控制的效果。
56 例 2 型糖尿病患者随机分为 IH 辅导 6 个月组（干预组）或常规护理（对照组）。通过电话进行 14 次 30 分钟的辅导。患者被引导制定个性化的健康愿景，目标由患者自行选择，以符合个人价值观。辅导议程、讨论主题和目标都是患者的，而不是提供者的。干预前和干预后评估测量药物依从性、运动频率、患者参与度、心理社会变量和 A1C。
与对照组相比，IH 辅导组患者对药物依从性的感知障碍减少，而患者激活、感知社会支持和益处发现均增加。在辅导组中，自我报告的依从性、运动频率、压力和感知健康状况也有改善。基线 A1C（>/=7%）升高的辅导参与者显著降低了他们的 A1C。
以患者价值观和目标感为重点的辅导干预可能为传统的糖尿病教育计划提供额外的益处。IH 辅导的基本原则可以由糖尿病教育者应用，以提高患者的自我效能、责任感和临床结果。
