Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK.
Diabet Med. 2020 Apr;37(4):545-554. doi: 10.1111/dme.14268. Epub 2020 Mar 9.
The last 20 years have witnessed a marked change in approaches to the management of type 1 diabetes in the UK. This is exemplified by National Institute of Health and Care Excellence (NICE) guidance which acknowledges that reaching and maintaining target glucose depends on people with type 1 diabetes effectively implementing flexible intensive insulin therapy. The guidance emphasizes that successful self-management requires the acquisition of complex skills and is best achieved by participation in high-quality structured education. Controlled trials and other research have shown that programmes teaching self-management can lower glucose levels while reducing hypoglycaemia, improve psychological outcomes and are highly cost-effective. An important principle of successful programmes is therapeutic education in which learning becomes a partnership between the professional and the person with diabetes who learns to fit diabetes into his/her everyday life. Other recommended elements of programmes include a written curriculum, group teaching by a professional multidisciplinary team and quality assurance. Yet many participants struggle post-course to implement and maintain skills, and overall HbA levels, particularly in the UK, remain far from target. Recent studies have identified the barriers to sustained effective self-management and concluded that even high-quality programmes generally lack critical components. These include incorporating evidence from behaviour change research, exploiting the promise of new technologies in reducing the burden of self-management, and providing structured professional support once people have completed the training. Studies are currently underway to evaluate structured training courses which have added these elements and examine whether they can lower glucose to levels closer to target without impairing quality of life.
在过去的 20 年中，英国对 1 型糖尿病管理方法的态度发生了显著变化。这一点在英国国家卫生与保健优化研究所（NICE）的指导意见中得到了体现，该意见承认，要达到并维持目标血糖水平，取决于 1 型糖尿病患者能否有效地实施灵活的强化胰岛素治疗。该指导意见强调，成功的自我管理需要掌握复杂的技能，而这最好通过参加高质量的结构化教育来实现。对照试验和其他研究表明，教授自我管理技能的项目可以降低血糖水平，同时减少低血糖，改善心理结果，并且具有很高的成本效益。成功项目的一个重要原则是治疗性教育，在这种教育中，学习成为专业人员和糖尿病患者之间的伙伴关系，使患者学会将糖尿病融入日常生活。项目中还推荐其他一些要素，包括书面课程、由专业多学科团队进行的小组教学以及质量保证。然而，许多参与者在课程结束后难以实施和维持技能，总体而言，HbA 水平，特别是在英国，远未达到目标。最近的研究已经确定了持续有效自我管理的障碍，并得出结论，即使是高质量的项目通常也缺乏关键要素。这些要素包括将行为改变研究的证据纳入其中，利用新技术在减轻自我管理负担方面的潜力，以及在人们完成培训后提供结构化的专业支持。目前正在进行研究，以评估增加了这些要素的结构化培训课程，并研究它们是否可以在不降低生活质量的情况下将血糖降低到更接近目标的水平。
