Weller Susan C, Baer Roberta, Nash Anita, Perez Noe
Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Department of Anthropology, University of South Florida, Tampa, Florida, USA.
BMJ Open Diabetes Res Care. 2017 May 8;5(1):e000349. doi: 10.1136/bmjdrc-2016-000349. eCollection 2017.
This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management.
Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C <7.0%), fair (7.0%<A1C<8.0%) or poor (A1C >8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups.
Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose.
Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control.
本项目探讨了血糖控制良好和不佳的患者的生活方式，以确定自然形成的有助于成功管理糖尿病的行为和策略。
对成年2型糖尿病患者进行半结构化访谈，内容涉及饮食、食物制备、体育活动、药物使用和血糖监测。患者（n = 56）被分为血糖控制良好（糖化血红蛋白<7.0%）、中等（7.0%<糖化血红蛋白<8.0%）或不佳（糖化血红蛋白>8.0%）组，并根据糖尿病病程（±5年）和药物治疗方式（无、口服、胰岛素±口服）在各组间进行匹配，以控制非生活方式因素。进行定性比较分析以确定区分血糖组别的行为。
血糖控制良好的患者更有可能每天检测血糖两次或更多次，减少钠摄入，增加水果和蔬菜摄入并控制食量，一些患者在不运动的情况下也实现了良好控制。血糖控制中等的患者讨论了几种饮食策略，包括限制甜食、饮用无热量饮料、减少碳水化合物摄入、“欺骗餐”（一餐只吃少量甜食/限制碳水化合物摄入，以便另一餐能多吃一些），并且每天检测一次血糖。血糖控制不佳的患者更有可能漏服抗糖尿病药物且不检测血糖。
尽管临床试验表明，大多数自我管理行为随着时间推移效果有限，但增加血糖监测是日常管理中的一个重要组成部分。需要对强调钠监测并允许一定程度“欺骗餐”的饮食策略的有效性进行研究。再次提供糖尿病教育课程并提供药盒作为记忆辅助工具可能有助于改善血糖控制不佳的情况。
