Daneman D, Epstein L H, Siminerio L, Beck S, Farkas G, Figueroa J, Becker D J, Drash A L
Diabetes Care. 1982 Sep-Oct;5(5):472-8. doi: 10.2337/diacare.5.5.472.
We implemented a three-phase, 32-wk program to improve both self-regulation of adherence behaviors and insulin delivery in children with diabetes. Twenty children, aged 8-12 yr (mean duration 3.6 yr), enrolled. Phase 1 (wk 1-12) used behavior modification to improve diet, exercise, urine testing, and insulin adjustment, targeting an increased percentage negative urines. Feedback training and parent checks were used to improve reliability; adherence was measured using Clinitest placebos. Phase 2 (wk 13-20) was a stabilization period. Phase 3 (wk 21-32) studied the effect of insulin dose adjustment, comparing once-versus twice-daily shots in 10 pairs of children matched for %GHb. GHb, fasting plasma glucose, and lipids were measured at baseline and at the end of each phase. Results revealed a significant and sustained increase in negative urine tests, but no change in % GHb or FBG. Reliability of and adherence to urine tests were 83% and 76%, respectively. During phase 3, no significant differences were noted between groups receiving once- or twice-daily insulin injections. Thus, behavior modification resulted in increased reliability and adherence to routines, associated with a reliable increase in negative urines. This did not, however, produce changes in other control measures. Furthermore, no differences between those receiving 1 or 2 daily shots were evident.
我们实施了一项为期32周的三阶段计划，以改善糖尿病儿童依从行为的自我调节和胰岛素给药情况。招募了20名年龄在8至12岁（平均病程3.6年）的儿童。第一阶段（第1至12周）采用行为矫正来改善饮食、运动、尿液检测和胰岛素调整，目标是增加阴性尿液的百分比。使用反馈训练和家长检查来提高可靠性；使用尿糖试纸安慰剂测量依从性。第二阶段（第13至20周）是一个稳定期。第三阶段（第21至32周）研究胰岛素剂量调整的效果，在10对根据糖化血红蛋白百分比匹配的儿童中比较每日一次与每日两次注射。在基线和每个阶段结束时测量糖化血红蛋白、空腹血糖和血脂。结果显示阴性尿液检测显著且持续增加，但糖化血红蛋白百分比或空腹血糖没有变化。尿液检测的可靠性和依从性分别为83%和76%。在第三阶段，接受每日一次或两次胰岛素注射的组之间没有观察到显著差异。因此，行为矫正导致对日常行为的可靠性和依从性增加，与阴性尿液的可靠增加相关。然而，这并未导致其他控制指标发生变化。此外，接受每日一次或两次注射的儿童之间没有明显差异。
