Maez L, Erickson L, Naumuk L
Univeristy of Cincinnati, Cincinnati, Ohio, USA.
Rural Remote Health. 2014;14(2):2742. Epub 2014 Jun 16.
Diabetes mellitus type II is a growing concern in the USA, with 6% of the population diagnosed with diabetes and another 5% having pre-diabetes. The prevalence of diabetes is 17% higher in rural areas than in central cities{1}. Adult diabetics living in rural areas often see negative outcomes related to their limited access to care, cultural barriers, and lack of educational resources. This article seeks to evaluate best evidence-based strategies directed at improving diabetic outcomes of rural populations through hemoglobin A1C (HbA1C) reductions.
A search of Medline, CIHNAL, PubMed, and Sage Pub was undertaken. The search was structured around the following key terms: adult, diabetes, education, hemoglobin a1c, and rural. The search limits were set to English-language publications between 2004 and 2012 in industrialized countries. Only articles from scholarly, peer-reviewed publications were considered. Literature that used an inpatient setting, focused on children or adolescents, and did not meet any inclusion criteria were excluded from this review.
A total of 15 articles met the selection criteria from the 1819 citations sourced from the search. After reviewing the sources, nutritional patient education, motivational counseling and lifestyle modifications were found to be the most influential factors that favorably changed measurable outcomes for this population. Education for providers did not have an appreciable effect on patient outcomes.
This review adds to the literature by outlining best-practice guidelines for evidence-based practice based on current research. Primary care providers in rural areas should encourage their patients to actively participate in diabetes education when possible, and provide this education in a culturally competent manner.
在美国，2型糖尿病日益受到关注，6%的人口被诊断患有糖尿病，另有5%患有糖尿病前期。农村地区的糖尿病患病率比中心城市高17%{1}。生活在农村地区的成年糖尿病患者往往因获得医疗服务的机会有限、文化障碍和缺乏教育资源而出现不良后果。本文旨在评估基于最佳证据的策略，通过降低糖化血红蛋白（HbA1C）来改善农村人口的糖尿病治疗效果。
对医学数据库（Medline）、护理及健康领域数据库（CIHNAL）、医学期刊数据库（PubMed）和Sage出版社数据库进行检索。检索围绕以下关键词展开：成人、糖尿病、教育、糖化血红蛋白和农村。检索范围限定为2004年至2012年工业化国家的英文出版物。仅考虑来自学术性、同行评审出版物的文章。使用住院环境、关注儿童或青少年且不符合任何纳入标准的文献被排除在本综述之外。
从检索到的1819篇文献中，共有15篇文章符合选择标准。在审查这些文献后发现，营养患者教育、动机咨询和生活方式改变是对该人群可测量结果产生有利影响的最具影响力的因素。对医疗服务提供者的教育对患者结果没有明显影响。
本综述通过概述基于当前研究的循证实践最佳实践指南，为文献增添了内容。农村地区的初级保健提供者应鼓励患者尽可能积极参与糖尿病教育，并以具有文化胜任力的方式提供这种教育。
