以家庭为中心的干预对 2 型糖尿病成人患者血糖结局的影响：FAMS 2.0 RCT 的主要、中介和亚组效应。
Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT.
机构信息
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Diabetes Res Clin Pract. 2023 Dec;206:110991. doi: 10.1016/j.diabres.2023.110991. Epub 2023 Nov 3.
AIMS
Family/friend Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS' effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT.
METHODS
Persons with diabetes (PWDs) were randomized to FAMS or control with their support person (family/friend, optional). FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period.
RESULTS
PWDs (N = 329) were 52 % male, 39 % reported minoritized race or ethnicity, with mean HbA1c 8.6 ± 1.7 %. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64 %; 95 % CI [-1.22 %, -0.05 %]), but overall mean effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27 %; 95 % CI [-0.49 %, -0.09 %]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19 %; 95 % CI [-0.40 %, -0.01 %]).
CONCLUSIONS
Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.
目的
家庭/朋友激励自我护理（FAMS）是一种通过手机提供的自我护理支持干预措施。我们在一项为期 15 个月的 RCT 中评估了 FAMS 对 2 型糖尿病患者的血红蛋白 A1c（HbA1c）和干预目标的影响。
方法
将糖尿病患者（PWD）随机分为 FAMS 组或对照组，其支持人员（家庭/朋友，可选）。FAMS 包括 PWD 每月一次的电话辅导和短信，以及支持人员在 9 个月的干预期间的短信。
结果
PWD（N=329）中 52%为男性，39%报告少数民族或种族，平均 HbA1c 为 8.6±1.7%。FAMS 改善了非同居支持人员的 PWD 的 HbA1c（-0.64%；95%CI[-1.22%，-0.05%]），但总体平均效果不显著。FAMS 在干预期间改善了干预目标，包括自我效能、饮食行为和家庭/朋友参与度；这些改善介导了干预后 HbA1c 的改善（总间接效应-0.27%；95%CI[-0.49%，-0.09%]），并在 12 个月时维持了 HbA1c 的改善（总间接效应-0.19%；95%CI[-0.40%，-0.01%]）。
结论
尽管大多数干预目标都有所改善，但只有与非同居支持人员有互动的 PWD 的 HbA1c 有所改善，这表明未来的家庭干预应强调包括这些关系。未来的工作还应努力确定介导 HbA1c 改善的干预目标。
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