1 Department of Pharmacy, National University of Singapore , Singapore, Singapore .
2 Department of Pharmacy and Tan Tock Seng Hospital , Singapore, Singapore .
Diabetes Technol Ther. 2018 Oct;20(10):698-703. doi: 10.1089/dia.2018.0159. Epub 2018 Sep 6.
Empowerment plays significant roles in the complex management of type 2 diabetes. International guidelines have provided recommendations on management of Muslims who fast during Ramadan. However, there remains a lack of patient-centered epistemic tool to empower healthcare providers and patients in managing diabetes during Ramadan. This study discussed the development and evaluation of such tool. The collaborative algorithm was developed with reference to the nominal group technique by a board-certified clinical pharmacist and discussed with endocrinologists, nurses, and family physicians. The empowerment component of the algorithm was developed based on the Basic Psychological Needs Theory. The algorithm was evaluated through a randomized controlled trial. Glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial glucose (PPG) levels and safety profiles in terms of hypoglycemic events were assessed. The collaborative algorithm was developed with four components: screening, education, dose modification by healthcare provider, and dose adjustment by patient. A total of 62 individuals were recruited, with 30 and 32 randomized into the intervention and control groups, respectively. The mean age was 58.4 years, with majority being females (67.7%). There was a reduction in mean HbA1c from 7.9% ± 0.9% to 7.5% ± 0.8% (P < 0.001) in the intervention group, while no significant difference was observed in the control group (P = 0.270). FPG (P < 0.001) and PPG (P = 0.002) also improved significantly in the intervention group. There were no major hypoglycemic events and minor hypoglycemia comparable between both groups (P = 0.465). The collaborative algorithm incorporated empowerment and promoted shared decision-making in diabetes management, hence promoting safe and effective fasting.
赋权在 2 型糖尿病的复杂管理中起着重要作用。国际指南为在斋月期间禁食的穆斯林患者的管理提供了建议。然而，在斋月期间管理糖尿病方面，仍然缺乏以患者为中心的认知工具来增强医疗保健提供者和患者的能力。本研究讨论了此类工具的开发和评估。该协作算法是在认证临床药剂师的名义群体技术的基础上制定的，并与内分泌学家、护士和家庭医生进行了讨论。该算法的赋权部分是基于基本心理需求理论制定的。该算法通过随机对照试验进行了评估。评估了糖化血红蛋白（HbA1c）、空腹血糖（FPG）和餐后血糖（PPG）水平以及低血糖事件方面的安全性概况。该协作算法由四个部分组成：筛查、教育、医疗保健提供者调整剂量和患者调整剂量。共招募了 62 人，其中 30 人和 32 人分别随机分为干预组和对照组。平均年龄为 58.4 岁，大多数为女性（67.7%）。干预组的平均 HbA1c 从 7.9%±0.9%降至 7.5%±0.8%（P<0.001），而对照组无显著差异（P=0.270）。FPG（P<0.001）和 PPG（P=0.002）也显著改善。两组之间均未发生重大低血糖事件和轻微低血糖事件（P=0.465）。协作算法纳入了赋权，并促进了糖尿病管理中的共同决策，从而促进了安全有效的禁食。
