Lanhers Charlotte, Duclos Martine, Guttmann Aline, Coudeyre Emmanuel, Pereira Bruno, Ouchchane Lemlih
Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital (CHU), BP 68, 63001, Clermont-Ferrand, Cedex 1, France; Clermont University, University of Auvergne, Clermont-Ferrand, France.
Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital (CHU), BP 68, 63001, Clermont-Ferrand, Cedex 1, France; Laboratory of Human Nutrition, INRA UMR 1019, Clermont-Ferrand, France; Clermont University, University of Auvergne, Clermont-Ferrand, France.
PLoS One. 2015 Oct 15;10(10):e0140429. doi: 10.1371/journal.pone.0140429. eCollection 2015.
AIMS/HYPOTHESIS: To describe barriers to physical activity (PA) in type 2 diabetes patients and their general practitioners (GPs), looking for practitioner's influence on PA practice of their patients.
We conducted a cross-sectional study on GPs (n = 48) and their type 2 diabetes patients (n = 369) measuring respectively barriers to prescribe and practice PA using a self-assessment questionnaire: barriers to physical activity in diabetes (BAPAD). Statistical analysis was performed accounting hierarchical data structure. Similar practitioner's patients were considered a cluster sharing common patterns.
The higher the patient's BAPAD score, the higher the barriers to PA, the higher the risk to declare practicing no PA (p<0.001), low frequency and low duration of PA (p<0.001). A high patient's BAPAD score was also associated with a higher risk to have HbA1c ≥7% (53 mmol/mol) (p = 0.001). The intra-class correlation coefficient between type 2 diabetes patients and GPs was 34%, indicating a high cluster effect. A high GP's BAPAD score, regarding the PA prescription, is predictive of a high BAPAD score with their patients, regarding their practice (p = 0.03).
CONCLUSION/INTERPRETATION: Type 2 diabetes patients with lower BAPAD score, thus lower barriers to physical activity, have a higher PA level and a better glycemic control. An important and deleterious cluster effect between GPs and their patients is demonstrated: the higher the GP's BAPAD score, the higher the type 2 diabetes patients' BAPAD score. This important cluster effect might designate GPs as a relevant lever for future interventions regarding patient's education towards PA and type 2 diabetes management.
目的/假设：描述2型糖尿病患者及其全科医生（GP）进行体育活动（PA）的障碍，探寻医生对患者PA行为的影响。
我们对48名全科医生及其369名2型糖尿病患者进行了一项横断面研究，分别使用一份自我评估问卷“糖尿病患者体育活动障碍（BAPAD）”来衡量开具PA处方和进行PA的障碍。采用考虑分层数据结构的统计分析方法。将同一医生的患者视为具有共同模式的一组。
患者的BAPAD得分越高，PA的障碍越高，宣称不进行PA的风险越高（p<0.001），PA的频率和持续时间越低（p<0.001）。患者的BAPAD得分高还与糖化血红蛋白（HbA1c）≥7%（53 mmol/mol）的风险较高相关（p = 0.001）。2型糖尿病患者和全科医生之间的组内相关系数为34%，表明存在较高的聚类效应。全科医生在PA处方方面的BAPAD得分高，预示着其患者在PA行为方面的BAPAD得分也高（p = 0.03）。
结论/解读：BAPAD得分较低、体育活动障碍较低的2型糖尿病患者，其PA水平较高，血糖控制较好。研究表明全科医生与其患者之间存在重要且有害的聚类效应：全科医生的BAPAD得分越高，2型糖尿病患者的BAPAD得分越高。这种重要的聚类效应可能表明全科医生是未来在患者PA教育和2型糖尿病管理方面进行干预的一个相关切入点。
