Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA.
Clin Ther. 2013 Jan;35(1):A43-53. doi: 10.1016/j.clinthera.2012.12.007.
A diabetes self-management education (DSME) program was offered to patients at a primary care clinic serving low-income people.
The purpose of the analyses presented here was to understand the feasibility of the program and effectiveness of the intervention.
The program was facilitated by a nurse and licensed dietician. Data were collected at baseline, after each class, and after 6 months. Patients were interviewed to identify diabetes self-care behaviors before the first class, after the fourth class, and at 6 months. Knowledge related to content areas was measured before and after each class. Glycosylated hemoglobin (HbA(1c)), blood pressure, weight, and body mass index (BMI) were collected at baseline and after 6 months. Medical records were reviewed for LDL levels, co-morbidity, and diabetes management. Frequencies, χ(2) and t tests, and repeated measures t tests were used to analyze data.
Patients were mostly non-Hispanic black or Hispanic (93.1%); mean BMI was 34.89 kg/m(2). About one-half (41.95%) completed the program. Significant improvements were observed for knowledge related to each of the 4 content areas: diet (P < 0.001), diabetes management (P = 0.003), monitoring blood glucose (P < 0.001), and preventing complications (P = 0.001). Among long-term outcomes, mean HbA(1c) was significantly reduced (0.82%), from 8.60% to 7.78% (P = 0.007), with 26.67% of patients reducing HbA(1c) from ≥7.0% at baseline to <7% at follow up (P < 0.001). Patients demonstrated a significant improvement in readiness to improve dietary behaviors (P = 0.016).
Outcomes suggested that minority patients with a high risk for poor diabetes outcomes might be retained in a multisession DSME program and benefit from increasing knowledge of diabetes content. Further evaluation is necessary to determine the cost-effectiveness of this intervention.
在一家为低收入人群服务的初级保健诊所为患者提供了糖尿病自我管理教育（DSME）计划。
本分析的目的是了解该计划的可行性和干预措施的有效性。
该计划由护士和持照营养师协助实施。在基线、每节课后和 6 个月时收集数据。在第一节课之前、第四节课之后和 6 个月时对患者进行访谈，以确定他们的糖尿病自我护理行为。在每节课前后测量与内容领域相关的知识。在基线和 6 个月后收集糖化血红蛋白（HbA1c）、血压、体重和体重指数（BMI）。审查医疗记录以了解 LDL 水平、合并症和糖尿病管理情况。使用频率、χ(2)和 t 检验以及重复测量 t 检验分析数据。
患者主要是非西班牙裔黑人或西班牙裔（93.1%）；平均 BMI 为 34.89kg/m(2)。约有一半（41.95%）完成了该计划。在与以下 4 个内容领域相关的知识方面，均观察到显著改善：饮食（P < 0.001）、糖尿病管理（P = 0.003）、监测血糖（P < 0.001）和预防并发症（P = 0.001）。在长期结果中，HbA1c 平均值显著降低（0.82%），从 8.60%降至 7.78%（P = 0.007），26.67%的患者将 HbA1c 从基线时的≥7.0%降至随访时的<7%（P < 0.001）。患者在改善饮食行为的准备程度方面表现出显著改善（P = 0.016）。
结果表明，糖尿病结局不良风险较高的少数族裔患者可能会被保留在多节 DSME 计划中，并从增加对糖尿病内容的了解中受益。需要进一步评估以确定该干预措施的成本效益。
