一项由护士主导、基于认知行为疗法的针对2型糖尿病控制不佳成年人的干预措施：一项随机对照试验。

A nurse-led education and cognitive behaviour therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial.

作者信息

Whitehead Lisa C, Crowe Marie T, Carter Janet D, Maskill Virginia R, Carlyle Dave, Bugge Carol, Frampton Chris M A

机构信息

School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia.

Centre for Postgraduate Nursing Studies & Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.

出版信息

J Eval Clin Pract. 2017 Aug;23(4):821-829. doi: 10.1111/jep.12725. Epub 2017 Apr 11.

DOI:10.1111/jep.12725

PMID:28397334

Abstract

RATIONALE, AIMS AND OBJECTIVES: Diabetes mellitus is associated with significant morbidity, mortality, and escalating health care costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short-term and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes. The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) was effective in reducing hemoglobin A (HbA ) in people living with uncontrolled type 2 diabetes compared to usual care.

METHODS

Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA outside of the recommended range (4%-7%, 20-53 mmol/mol) for 12 months or more, were eligible to participate. Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention, or a usual care. One hundred and eighteen participants completed baseline data collection (N = 34 education group, N = 39 education plus ACT, N = 45 control group). An intention to treat analysis was used.

RESULTS

A statistically significant reduction in HbA in the education intervention group was found (P = .011 [7.48, 8.14]). At 6 months, HbA was reduced in both intervention groups (education group -0.21 and education and ACT group -0.04) and increased in the control group (+0.32). A positive change in HbA (HbA reduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group.

CONCLUSIONS

At 6 months post intervention, HbA was reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention.

摘要

原理、目的和目标：糖尿病与严重的发病率、死亡率以及不断攀升的医疗保健成本相关。研究一直表明血糖控制对于延缓糖尿病短期和长期并发症的发生以及降低其发病率具有重要意义。尽管血糖控制难以实现且维持具有挑战性，但它是减少不良疾病结局的关键。本研究的目的是确定与常规护理相比，单纯由护士主导的教育干预或采用教育与接纳承诺疗法（ACT）的护士主导干预在降低未控制的2型糖尿病患者的糖化血红蛋白（HbA）水平方面是否有效。

方法

年龄在18岁以上、确诊为2型糖尿病且HbA超出推荐范围（4%-7%，20-53 mmol/mol）达12个月或更长时间的成年人有资格参与。参与者被随机分为接受护士主导的教育干预组、护士主导的教育加ACT干预组或常规护理组。118名参与者完成了基线数据收集（教育组N = 34，教育加ACT组N = 39，对照组N = 45）。采用意向性分析。

结果

发现教育干预组的HbA有统计学显著降低（P = 0.011 [7.48, 8.14]）。在6个月时，两个干预组的HbA均降低（教育组降低0.21，教育与ACT组降低0.04），而对照组升高（升高0.32）。总体上有50名参与者的HbA出现了正向变化（HbA降低）。与对照组相比，干预组中表现出改善的参与者数量是对照组的两倍（教育组为56%，教育加ACT组为51%，对照组为24%）。