Mohd Zahiruddin Wan, Ahmad Siti Rohana, Yaacob Nor Azwany, Mohd Shariff Noorsuzana, Jaeb Mat Zuki, Hussin Zalmizy
School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia.
State Health Department of Kedah, Alor Setar 05400, Malaysia.
Healthcare (Basel). 2023 Jul 4;11(13):1929. doi: 10.3390/healthcare11131929.
(1) Background: Achieving successful tuberculosis (TB) treatment outcomes among diabetic patients is a real challenge as TB complicates control of diabetes. This study aimed to evaluate the effectiveness of an integrated dual management educational module, MID-DOTS, which uses the mmotivational interviewing (MI) technique implemented within directly observed treatment as part of a short course (DOTS) program in TB patients with diabetes (TB/DM). A randomized controlled trial was conducted in the northeastern state of Malaysia. (2) Methods: One hundred and twenty-four TB patients with diabetes received educational intervention using a MID-DOT module that used the MI technique, which was repetitively applied by TB nurses throughout a 6-month DOTS program while another 122 patients were given standard health education. Study outcomes include the proportion of patients with successful TB treatment, and changes in HbA1c and diabetic self-care scores at 6 months. (3) Results: The successful TB treatment outcome was 88% in the intervention group versus 72% in the control group (RR = 1.24; 95%CI 1.16, 1.58). A significant reduction of HbA1c (mean difference 0.82%; 95%CI 0.66, 0.98) and significantly higher diabetes self-care score (mean difference 8.49; 95%CI 7.38, 9.59) were also shown in the intervention group. (4) Conclusions: A dual TB/DM educational strategy which integrates the MI technique applied repetitively within the DOTS program is effective in increasing successful TB treatment as well as improving diabetic outcomes.
（1）背景：在糖尿病患者中实现成功的结核病治疗结果是一项真正的挑战，因为结核病会使糖尿病的控制复杂化。本研究旨在评估一种综合双重管理教育模块MID-DOTS的有效性，该模块采用动机性访谈（MI）技术，作为短期疗程（DOTS）计划的一部分在糖尿病合并结核病（TB/DM）患者的直接观察治疗中实施。在马来西亚东北部州进行了一项随机对照试验。（2）方法：124名糖尿病合并结核病患者接受了使用MID-DOT模块的教育干预，该模块采用MI技术，结核病护士在为期6个月的DOTS计划中反复应用该技术，而另外122名患者接受了标准健康教育。研究结果包括结核病治疗成功的患者比例，以及6个月时糖化血红蛋白（HbA1c）和糖尿病自我护理评分的变化。（3）结果：干预组结核病治疗成功的比例为88%，而对照组为72%（相对危险度=1.24；95%置信区间1.16，1.58）。干预组的糖化血红蛋白也显著降低（平均差异0.82%；95%置信区间0.66，0.98），糖尿病自我护理评分显著更高（平均差异8.49；95%置信区间7.38，9.59）。（4）结论：一种双重TB/DM教育策略，即在DOTS计划中反复应用MI技术，在提高结核病治疗成功率以及改善糖尿病治疗结果方面是有效的。
