Vinicor F, Cohen S J, Mazzuca S A, Moorman N, Wheeler M, Kuebler T, Swanson S, Ours P, Fineberg S E, Gordon E E
J Chronic Dis. 1987;40(4):345-56. doi: 10.1016/0021-9681(87)90050-6.
To examine the effects of intensive patient and/or physician diabetes education on patient health outcomes, a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were randomly assigned to: routine care; patient education; physician education; or both patient and physician education. Patient outcome data were analyzed either by analysis of covariance on post intervention values (2-hour post-prandial plasma glucose [PPG]; body weight [BW]; blood pressure [BP]; or analysis of variance conducted on change values (fasting plasma glucose [FPG] and glycosylated hemoglobin [A1Hgb]). After patient education, significant improvements were observed in FPG, A1Hgb, BW, and systolic and diastolic BP. Physician education resulted in significant decreases in FPG, A1Hgb and BW. The combination of patient plus physician education resulted in the greatest improvements in patients' health outcomes including FPG, A1Hgb, PPG, BW and diastolic BP. Adjusted systolic BPs were not significantly different in the two groups. While these physiologic improvements were statistically and probably clinically significant, hyperglycemia and obesity still persisted. Thus, achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of resources than currently estimated.
为了研究强化患者和/或医生糖尿病教育对患者健康结局的影响，进行了一项对照试验，将内科住院医师及其532名糖尿病患者随机分为：常规护理组；患者教育组；医生教育组；患者和医生教育组。患者结局数据通过对干预后值进行协方差分析（餐后2小时血糖[PPG]、体重[BW]、血压[BP]）或对变化值进行方差分析（空腹血糖[FPG]和糖化血红蛋白[A1Hgb]）来分析。患者教育后，FPG、A1Hgb、BW以及收缩压和舒张压均有显著改善。医生教育使FPG、A1Hgb和BW显著降低。患者加医生教育的组合使患者的健康结局得到最大改善，包括FPG、A1Hgb、PPG、BW和舒张压。两组的调整后收缩压无显著差异。虽然这些生理改善在统计学上以及可能在临床上具有显著意义，但高血糖和肥胖仍然存在。因此，对于像糖尿病这样的慢性病，要实现最佳患者结局可能需要比目前估计更多或更有效的资源利用。
