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行为与教育干预对改善伴糖尿病的严重精神疾病成人的血糖控制

Improved Glycemic Control in Adults With Serious Mental Illness and Diabetes With a Behavioral and Educational Intervention.

机构信息

Center for Addiction Medicine, Department of Psychiatry (Schnitzer, Cather, Vilme, Dechert, Evins), Schizophrenia Research Program (Schnitzer, Cather, Freudenreich, MacLaurin, Vilme, Dechert, Evins), Diabetes Center, Department of Medicine (Wexler) and General Medicine Division, Department of Medicine (Thorndike), Department of Biostatistics (Potter), all at Massachusetts General Hospital (MGH), Boston; Erich Lindemann Mental Health Center, Freedom Trail Clinic, Boston (Freudenreich, MacLaurin).

出版信息

Psychiatr Serv. 2020 Jul 1;71(7):730-733. doi: 10.1176/appi.ps.201900336. Epub 2020 Apr 23.

Abstract

OBJECTIVE

The purpose of this study was to evaluate a 16-week, reverse-integrated care (bringing primary care interventions/services into the psychiatric setting) behavioral and educational group intervention for individuals with serious mental illness and diabetes.

METHODS

The primary outcome was change in glycated hemoglobin (HbA1c). Secondary outcomes included body mass index (BMI), blood pressure, lipid levels, physical activity, diabetes knowledge, and self-care.

RESULTS

Thirty-five participants attended at least one group and were included in a modified intent-to-treat analysis. From baseline to week 16, HbA1c improved, from 7.5±1.6 to 7.1±1.4, p=0.01, and BMI improved, from 33.3±3.8 to 32.9±4.1, p<0.001, as did measures of diabetes knowledge and self-care. One-year follow-up in a subset of participants showed no evidence of rebound in HbA1c.

CONCLUSIONS

This 16-week behavioral and educational group intervention resulted in improvements in glycemic control, BMI, diabetes knowledge, and self-care. The results warrant larger-scale, controlled trial testing of this intervention to improve diabetes-related health outcomes in those with serious mental illness.

摘要

目的

本研究旨在评估一项为期 16 周的反向综合护理(将初级保健干预措施/服务引入精神科环境)行为和教育团体干预,以治疗患有严重精神疾病和糖尿病的个体。

方法

主要结局指标为糖化血红蛋白(HbA1c)的变化。次要结局指标包括体重指数(BMI)、血压、血脂水平、身体活动、糖尿病知识和自我护理。

结果

35 名参与者至少参加了一次小组活动,并进行了改良意向治疗分析。从基线到第 16 周,HbA1c 从 7.5±1.6 降至 7.1±1.4,p=0.01,BMI 从 33.3±3.8 降至 32.9±4.1,p<0.001,糖尿病知识和自我护理的测量结果也得到改善。在部分参与者的一年随访中,HbA1c 没有反弹的证据。

结论

这项为期 16 周的行为和教育团体干预措施可改善血糖控制、BMI、糖尿病知识和自我护理。这些结果证明需要更大规模的对照试验来测试这种干预措施,以改善患有严重精神疾病的个体的糖尿病相关健康结局。

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Modified intention-to-treat analysis did not bias trial results.改良意向性分析未使试验结果产生偏差。
J Clin Epidemiol. 2016 Apr;72:66-74. doi: 10.1016/j.jclinepi.2015.11.003. Epub 2015 Nov 10.
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Clinical management of comorbid diabetes and psychotic disorders.糖尿病与精神障碍共病的临床管理
Lancet Psychiatry. 2015 May;2(5):465-476. doi: 10.1016/S2215-0366(15)00105-4. Epub 2015 Apr 28.

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