药剂师胰岛素注射再教育对基层医疗诊所II型糖尿病患者血糖控制的影响。
Impact of pharmacist insulin injection re-education on glycemic control among type II diabetic patients in primary health clinics.
作者信息
Selvadurai Selvakumari, Cheah Kit Yee, Ching Min Wei, Kamaruddin Hanisah, Lee Xiao You, Ngajidin Radhiatul Mardhiyah, Lee Xian Hui, Mohd Ali Lina Mariana
机构信息
Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur & Putrajaya, Jalan Cenderasari, Tasik Perdana, 50480 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Centre for Clinical Trial, Institute for Clinical Research, National Institute of Health, Kompleks Institut Kesihatan Negara (NIH), No. 1, Jalan Setia Murni U13/52 Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia.
出版信息
Saudi Pharm J. 2021 Jul;29(7):670-676. doi: 10.1016/j.jsps.2021.04.028. Epub 2021 Apr 30.
BACKGROUND
Insulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control.
OBJECTIVES
To evaluate the impact of pharmacist's monthly re-education on insulin injection technique (IT), lipohypertrophy, patients' perception on insulin therapy and its effect on glycaemic control.
METHODS
This randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government health clinics. 160 diabetics with baseline HbA1 ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)).
RESULTS
139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient's perception. Mean HbA1 decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p < 0.001). Monthly re-education improved patient's perception towards insulin therapy (ITAS score reduced 1.44 ± 2.36; p = 0.021). Between groups, interventional arm shown significantly better improvement in all outcomes. Improvement was shown in IT technique (+2.02 score; p < 0.001), medication adherence (+1.48 score; p < 0.001) and ITAS (-1.99 score; p = 0.037). Mean HbA1 reduced an additional of 0.63% (p = 0.008) compared to control arm.
CONCLUSION
Re-education is more effective in increasing adherence, reducing lipohypertrophy, improving injection technique and patient's perception on insulin therapy, thereby providing better glycaemic control.
背景
胰岛素注射技术再教育和糖尿病知识强化已使血糖控制得到改善。
目的
评估药剂师每月进行的再教育对胰岛素注射技术（IT）、脂肪增生、患者对胰岛素治疗的认知及其对血糖控制的影响。
方法
这项随机对照、多中心研究在15家政府健康诊所的2型糖尿病患者中开展。160名基线糖化血红蛋白（HbA1）≥8%且胰岛素注射技术不佳的糖尿病患者被随机分为对照组或干预组。对照组在初始阶段和第4个月接受标准的药剂师咨询。干预组接受为期4个月的每月一次咨询和胰岛素注射技术再教育。使用经过验证的研究工具胰岛素治疗评估量表（ITAS）和药物依从性问卷（MCQ）对糖尿病、胰岛素注射技术知识、依从性和对糖尿病的认知进行评估。
结果
139名患者完成了研究；对照组（69名），干预组（70名）。在对照组中，除患者认知外，所有结果均有改善。平均糖化血红蛋白降低了0.79%±0.24（p = 0.001）。在干预组中，所有结果均显著改善。糖化血红蛋白显著降低1.19%±0.10（p < 0.001）。每月一次的再教育改善了患者对胰岛素治疗的认知（ITAS评分降低1.44±2.36；p = 0.021）。在组间比较中，干预组在所有结果方面均显示出显著更好的改善。胰岛素注射技术（评分提高2.02；p < 0.001）、药物依从性（评分提高1.48；p < 0.001）和ITAS（评分降低1.99；p = 0.037）均有改善。与对照组相比，平均糖化血红蛋白额外降低了0.63%（p = 0.008）。
结论
再教育在提高依从性、减少脂肪增生、改善注射技术以及患者对胰岛素治疗的认知方面更有效，从而能更好地控制血糖。
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