Beverly Elizabeth A, Fitzgerald Shane M, Brooks Kelly M, Hultgren Brittney A, Ganda Om P, Munshi Medha, Weinger Katie
Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
Diabetes Educ. 2013 Jul-Aug;39(4):504-14. doi: 10.1177/0145721713486837. Epub 2013 May 2.
The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education.
In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline.
Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time.
Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.
本研究旨在评估强化糖尿病自我管理对于改善2型糖尿病成年患者血糖水平及自我护理的价值，这些患者此前至少接受过3小时的糖尿病教育。
在这项随机对照试验中，134名参与者（75%为白人，51%为女性，年龄59±9岁，患糖尿病13±8年，糖化血红蛋白[A1C]=8.4%±1.2%）被随机分为基于群组地图的项目组（干预组）或胆固醇与血压群组教育组（对照组）。在基线、干预后3个月、6个月和12个月时评估参与者的A1C水平、糖尿病自我护理行为（3天计步器读数、6分钟步行试验、血糖检测、自我护理频率）以及心理社会因素（痛苦、沮丧、生活质量），并在基线时评估健康素养。
两组在包括A1C水平、健康素养或自我护理等基线特征方面无差异；然而，干预组的受教育年限比对照组更多。干预组参与者在干预后3个月时A1C水平有适度改善，但在6个月和12个月时未维持该改善，而对照组患者在随访期间任何时候A1C水平均未改善。重要的是，随着时间推移，两组自我报告的自我护理频率、糖尿病生活质量、糖尿病相关痛苦以及对糖尿病自我护理的沮丧感均有所改善。
对未达血糖目标的患者通过糖尿病教育强化自我护理有助于改善糖化血红蛋白，可被视为持续糖尿病护理的必要组成部分。需要确定实现强化的最佳方法。
