Creighton University, MPH Program, Omaha, Nebraska (Prof Wilken).
Creighton University School of Dentistry, Omaha, Nebraska (Dr Nunn).
Diabetes Educ. 2017 Aug;43(4):388-395. doi: 10.1177/0145721717706765. Epub 2017 May 11.
Purpose The purpose of this study was to determine if the use of both the Talking Circles (TCs) and diabetes self-management education (DSME) results in better adherence and outcomes for diabetes self-management than DSME alone in American Indians (AIs) with type 2 diabetes mellitus (T2DM). Methods A quasiexperimental, mixed-methods approach was used for AIs with uncontrolled T2DM, defined by an A1C > 7.0%. The experimental group (n = 20) participated in a TC and received DSME. The control group (n = 19) received only DSME. Talking Circles were audio-taped and analyzed qualitatively. Quantitative data were analyzed using the generalized estimating equation and Fisher exact test for all study participants every 3 months for 1 year. Results Themes identified by TC participants were spirituality, gratitude, and sharing. Major topics of discussion were the experiences of living with T2DM, including challenges and coping. Evidence of positive trends for the experimental group who received the TC intervention included lower systolic blood pressure, lower A1C, lower weight over time, and increased adherence without incentives. Conclusion Talking Circles may have utility in improving adherence in AI adults with uncontrolled T2DM. Further studies are warranted, including extending the use of the TCs after completion of DSME sessions.
目的 本研究旨在确定在 2 型糖尿病（T2DM）的美国印第安人（AI）中，使用谈话圈（TCs）和糖尿病自我管理教育（DSME）是否比单独进行 DSME 更能提高糖尿病自我管理的依从性和效果。
方法 采用准实验、混合方法研究患有未控制的 T2DM 的 AI，其糖化血红蛋白（A1C）＞7.0%。实验组（n=20）参加了 TC 并接受了 DSME。对照组（n=19）仅接受 DSME。TC 参与者的音频记录进行了定性分析。对所有研究参与者，在 1 年内每 3 个月使用广义估计方程和 Fisher 精确检验进行定量数据分析。
结果 TC 参与者确定的主题包括精神性、感恩和分享。讨论的主要话题是与 T2DM 共存的经历，包括挑战和应对。实验组接受 TC 干预的证据显示出积极的趋势，包括收缩压降低、A1C 降低、体重随时间增加、以及在没有激励的情况下增加了依从性。
结论 谈话圈可能有助于提高未控制的 T2DM 的 AI 成人的依从性。需要进一步的研究，包括在 DSME 结束后扩展 TCs 的使用。
