Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
Diabet Med. 2011 May;28(5):532-8. doi: 10.1111/j.1464-5491.2011.03243.x.
Conventional insulin therapy requires patients with Type 1 diabetes to adhere to rigid dietary and insulin injection practices. Recent trends towards flexible intensive insulin therapy enable patients to match insulin to dietary intake and lifestyle; however, little work has examined patients' experiences of incorporating these practices into real-life contexts. This qualitative longitudinal study explored patients' experiences of using flexible intensive insulin therapy to help inform the development of effective long-term support.
Semi-structured interviews were conducted with 30 adult patients with Type 1 diabetes following participation in a structured education programme on using flexible intensive insulin therapy, and 6 and 12 months post-course. Longitudinal data analysis used an inductive, thematic approach.
Patients consistently reported feeling committed to and wanting to sustain flexible intensive insulin therapy. This regimen was seen as a logical and effective method of self-management, as patients experienced improved blood glucose readings and/or reported feeling better. Implementing and sustaining flexible intensive insulin therapy was enhanced when patients had stable routines, with more challenges reported by those working irregular hours and during weekends/holidays. Some patients re-crafted their lives to make this approach work for them; for instance, by creating dietary routines or adjusting dietary choices.
Clinical data have shown that flexible intensive insulin therapy can lead to improvement in glycaemic control. This study, drawing on patients' perspectives, provides further endorsement for flexible intensive insulin therapy by demonstrating patients' liking of, and their motivation to sustain, this approach over time. To help patients implement and sustain flexible intensive insulin therapy, follow-up support should encourage them to identify routines to better integrate this regimen into their lives.
传统的胰岛素治疗要求 1 型糖尿病患者严格遵循饮食和胰岛素注射规定。最近，灵活强化胰岛素治疗的趋势使患者能够根据饮食摄入和生活方式调整胰岛素用量；然而，很少有研究探讨患者将这些实践融入现实生活环境的经验。本纵向定性研究旨在探索患者使用灵活强化胰岛素治疗的经验，以为开发有效的长期支持提供信息。
对 30 名参加了关于使用灵活强化胰岛素治疗的结构化教育课程的 1 型糖尿病成年患者进行了半结构化访谈，并在课程结束后 6 个月和 12 个月进行了随访。采用归纳式主题分析法对纵向数据进行分析。
患者始终报告说他们致力于并希望维持灵活强化胰岛素治疗。这种治疗方案被视为一种合乎逻辑且有效的自我管理方法，因为患者的血糖读数得到了改善，或者他们感觉更好。当患者有稳定的日常生活规律时，实施和维持灵活强化胰岛素治疗会更加顺利，而那些工作时间不规律或周末/节假日工作的患者则报告面临更多挑战。一些患者重新规划自己的生活，以使这种方法适合他们；例如，通过创建饮食常规或调整饮食选择。
临床数据表明，灵活强化胰岛素治疗可改善血糖控制。本研究从患者的角度进一步支持了灵活强化胰岛素治疗，证明了患者随着时间的推移对这种方法的喜爱和维持动力。为了帮助患者实施和维持灵活强化胰岛素治疗，随访支持应鼓励他们确定日常生活规律，以便更好地将这种治疗方案融入他们的生活。
