Bastyr University Research Institute, Kenmore, WA 98028, USA.
BMC Complement Altern Med. 2012 Apr 18;12:44. doi: 10.1186/1472-6882-12-44.
Several small, uncontrolled studies have found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians. To extend these findings and determine the feasibility and promise of a randomized clinical trial, we conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC) in primary care patients with inadequately controlled type 2 diabetes.
Forty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c) values between 7.5-9.5 % and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight). Standardized instruments were administered by telephone to collect outcome data on self-care, self-efficacy, diabetes problem areas, perceived stress, motivation, and mood. Changes from baseline scores were calculated at 6- and 12-months after entry into the study. Six and 12-month changes in clinical risk factors (i.e., HbA1c, lipid and blood pressure) were calculated for the ANC cohort, and compared to changes in a cohort of 329 eligible, non-participating patients constructed using electronic medical records data. Between-cohort comparisons were adjusted for age, gender, baseline HbA1c, and diabetes medications. Six months was pre-specified as the primary endpoint for outcome assessment.
Participants made 3.9 ANC visits on average during the year, 78 % of which occurred within six months of entry into the study. At 6-months, significant improvements were found in most patient-reported measures, including glucose testing (P = 0.001), diet (P = 0.001), physical activity (P = 0.02), mood (P = 0.001), self-efficacy (P = 0.0001) and motivation to change lifestyle (P = 0.003). Improvements in glucose testing, mood, self-efficacy and motivation to change lifestyle persisted at 12-months (all P < 0.005). For clinical outcomes, mean HbA1c decreased by -0.90 % (P = 0.02) in the ANC cohort at 6-months, a -0.51 % mean difference compared to usual care (P = 0.07). Reductions at 12-months were not statistically significant (-0.34 % in the ANC cohort, P = 0.14; -0.37 % difference compared to the usual care cohort, P = 0.12).
Improvements were noted in self-monitoring of glucose, diet, self-efficacy, motivation and mood following initiation of ANC for patients with inadequately controlled type 2 diabetes. Study participants also experienced reductions in blood glucose that exceeded those for similar patients who did not receive ANC. Randomized clinical trials will be necessary to determine if ANC was responsible for these benefits.
几项小型、非对照研究发现，接受有照自然疗法医生治疗的 2 型糖尿病患者，其自我护理行为有所改善，临床风险降低。为了扩展这些发现并确定随机临床试验的可行性和前景，我们进行了一项前瞻性研究，以衡量辅助自然疗法护理（ANC）对控制不佳的 2 型糖尿病的主要护理患者的影响。
从一家大型综合医疗保健系统邀请了 40 名 2 型糖尿病患者，他们最多可以接受 8 次 ANC 访问，为期一年。参与者的糖化血红蛋白（HbA1c）值需要在 7.5-9.5%之间，并且至少有一个额外的心血管风险因素（即高血压、高血脂或超重）。通过电话使用标准化工具收集自我护理、自我效能、糖尿病问题领域、感知压力、动机和情绪方面的结果数据。在进入研究后的 6 个月和 12 个月计算基线得分的变化。计算 ANC 组的临床风险因素（即 HbA1c、血脂和血压）的 6 个月和 12 个月变化，并与使用电子病历数据构建的 329 名合格但未参与的患者的队列变化进行比较。两组间比较根据年龄、性别、基线 HbA1c 和糖尿病药物进行了调整。6 个月是主要终点，用于评估结果。
参与者在一年内平均接受了 3.9 次 ANC 访问，其中 78%的访问发生在进入研究后的 6 个月内。在 6 个月时，发现大多数患者报告的指标都有显著改善，包括血糖检测（P=0.001）、饮食（P=0.001）、体力活动（P=0.02）、情绪（P=0.001）、自我效能（P=0.0001）和改变生活方式的动机（P=0.003）。在 12 个月时，血糖检测、情绪、自我效能和改变生活方式的动机方面的改善仍然存在（均 P<0.005）。在临床结果方面，ANC 组在 6 个月时的平均 HbA1c 下降了-0.90%（P=0.02），与常规护理相比，平均差异为-0.51%（P=0.07）。12 个月时的下降无统计学意义（ANC 组为-0.34%，P=0.14；与常规护理组相比，差异为-0.37%，P=0.12）。
在开始接受 ANC 治疗后，控制不佳的 2 型糖尿病患者的血糖自我监测、饮食、自我效能、动机和情绪方面均有改善。研究参与者的血糖也有所降低，超过了未接受 ANC 的类似患者的降低水平。需要进行随机临床试验来确定 ANC 是否是这些益处的原因。
