An Lingwang, Yeh Kuei-Chun, Liu Yunxia, Wang Dandan, Li Xianglan, Tang Qi, Lu Juming
Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People's Republic of China.
Department of Endocrinology, The General Hospital of the People's Liberation Army, Beijing, 100853, People's Republic of China.
J Multidiscip Healthc. 2023 Sep 7;16:2641-2654. doi: 10.2147/JMDH.S414102. eCollection 2023.
We explore the effect of a structured online DSMES program on glycaemic control and the self-management behaviour of adolescents and young adults with T1DM.
We used a pre-post uncontrolled intervention design over a period of 6 months. A total of 37 youths with T1DM aged 10-45 years were enrolled. The intervention comprised 11 structured online DSMES course sessions; these were video-based and delivered by a diabetes specialist, nurses and a dietitian. The primary outcome was a change in (glycated hemoglobin) HbA1c. The secondary outcomes were changes in hypoglycaemia frequency, time in target range (TIR) among patients using a continuous glucose monitoring (CGM) system and self-management behaviour; the latter was measured using a T1DM self-management scale for Chinese adults (SMOD-CA) and the Chinese version of the diabetic behaviour rating scale in adolescents with T1DM (DBRS).
Twenty-three (85.2%) participants attended ≥8 of the online sessions. There was a significant reduction in HbA1c (from 6.92% to 6.47%, P = 0.002), hypoglycaemic episodes (from 6.0 to 4.0 during the preceding month, P = 0.026) and a significant increase in TIR (from 74.0% to 80.5%, P = 0.027) and an increase in the SMOD-CA score (from 79.6 to 84.6, P = 0.026) in young adults. No significant change in glucose control, hypoglycaemic events or DBRS score were found among children and adolescents. The score of the 12-item version of the Barrett-Lennard Relationship Inventory (B-L RI:mini) indicated that more than half of the participants experienced congruence, positive regard, and an empathic understanding in this programme.
The online structured DSMES programme was effective in improving the glycaemic control and self-management behaviour of young adults with T1DM; however, integrating offline visits or appointments with online consultations may be necessary for youth patients.
我们探讨结构化在线糖尿病自我管理教育与支持（DSMES）项目对1型糖尿病（T1DM）青少年及青年患者血糖控制和自我管理行为的影响。
我们采用了为期6个月的前后对照非随机干预设计。共纳入37名年龄在10 - 45岁的T1DM青年患者。干预包括11节结构化在线DSMES课程；这些课程以视频为基础，由糖尿病专科医生、护士和营养师授课。主要结局指标为糖化血红蛋白（HbA1c）的变化。次要结局指标包括低血糖发作频率的变化、使用持续葡萄糖监测（CGM）系统的患者的目标范围内时间（TIR）变化以及自我管理行为变化；后者使用中国成人T1DM自我管理量表（SMOD - CA）和中文版T1DM青少年糖尿病行为评定量表（DBRS）进行测量。
23名（85.2%）参与者参加了≥8节在线课程。青年患者的HbA1c显著降低（从6.92%降至6.47%，P = 0.002），低血糖发作次数显著减少（前一个月从6.0次降至4.0次，P = 0.026），TIR显著增加（从74.0%增至80.5%，P = 0.027），SMOD - CA评分增加（从79.6增至84.6，P = 0.026）。儿童和青少年的血糖控制、低血糖事件或DBRS评分未发现显著变化。巴雷特 - 伦纳德关系量表12项版本（B - L RI:mini）评分表明，超过一半的参与者在该项目中体验到了一致性、积极关注和共情理解。
在线结构化DSMES项目对改善T1DM青年患者的血糖控制和自我管理行为有效；然而，对于青少年患者，可能需要将线下就诊或预约与在线咨询相结合。
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