Weinberger M, Kirkman M S, Samsa G P, Shortliffe E A, Landsman P B, Cowper P A, Simel D L, Feussner J R
Center for Health Services Research in Primary Care, Durham VAMC, NC, USA.
J Gen Intern Med. 1995 Feb;10(2):59-66. doi: 10.1007/BF02600227.
To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians.
Randomized, controlled trial.
Veterans Affairs general medical clinic.
275 veterans who had NIDDM and were receiving primary care from general internists.
Nurse-initiated contacts were made by telephone at least monthly to provide patient education (with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia), reinforce compliance with regimens, monitor patients' health status, facilitate resolution of identified problems, and facilitate access to primary care.
Glycemic control was assessed using glycosylated hemoglobin (GHb) and fasting blood sugar (FBS) levels. Health-related quality of life (HRQOL) was measured with the Medical Outcomes Study SF-36, and diabetes-related symptoms were assessed using patients' self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month.
At one year, between-group differences favored intervention patients for FBS (174.1 mg/dL vs 193.1 mg/dL, p = 0.011) and GHb (10.5% vs 11.1%, p = 0.046). Statistically significant differences were not observed for either SF-36 scores (p = 0.66) or diabetes-related symptoms (p = 0.23).
The intervention, designed to be a pragmatic, low-intensity adjunct to care delivered by physicians, modestly improved glycemic control but not HRQOL or diabetes-related symptoms.
研究在非胰岛素依赖型糖尿病患者两次就诊于初级保健医生期间，由护士协调实施的干预措施所产生的影响。
随机对照试验。
退伍军人事务部综合医疗诊所。
275名患有非胰岛素依赖型糖尿病且接受普通内科医生初级保健的退伍军人。
护士至少每月通过电话与患者联系，提供患者教育（特别强调治疗方案以及高血糖和低血糖的重要体征和症状），强化对治疗方案的依从性，监测患者的健康状况，促进解决已发现的问题，并便利患者获得初级保健服务。
使用糖化血红蛋白（GHb）和空腹血糖（FBS）水平评估血糖控制情况。采用医学结局研究简表36（Medical Outcomes Study SF-36）测量健康相关生活质量（HRQOL），并通过患者对前一个月高血糖和低血糖体征及症状的自我报告评估糖尿病相关症状。
在一年时，组间差异显示干预组患者的空腹血糖（174.1毫克/分升对193.1毫克/分升，p = 0.011）和糖化血红蛋白（10.5%对11.1%，p = 0.046）更优。在简表36评分（p = 0.66）或糖尿病相关症状（p = 0.23）方面未观察到统计学上的显著差异。
该干预措施旨在作为医生所提供治疗的实用、低强度辅助手段，适度改善了血糖控制，但未改善健康相关生活质量或糖尿病相关症状。
