Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, Snetselaar L, Splett P, Wylie-Rosett J
Diabetes Treatment Center, Salt Lake City, Utah, USA.
J Am Diet Assoc. 1998 Jan;98(1):62-70; quiz 71-2. doi: 10.1016/s0002-8223(98)00017-0.
Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life.
Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life.
SUBJECTS/SETTINGS: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods.
chi 2 Test, t test, and analysis of covariance.
Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful.
CONCLUSIONS/APPLICATIONS: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care of perceived quality of life.
评估不同工作环境下的营养师对1型糖尿病营养实践指南的接受程度和使用便利性；确定有实践指南时营养师的营养护理活动是否会发生变化；测量以糖化血红蛋白（HbA1c）衡量的患者血糖水平控制变化；比较患者对护理的满意度以及对生活质量的看法。
采用结果研究方法，招募志愿营养师并随机分配到常规护理组或实践指南组。1型糖尿病患者由营养师招募并随访3个月。结果指标包括营养师的护理活动、患者HbA1c水平的变化以及患者对生活质量的满意度和看法。
研究对象/环境：来自美国各地回应招募通知的营养师参与其中。他们的工作场所包括糖尿病转诊中心、内分泌诊所、初级保健和社区健康诊所、医院以及一家企业诊所。他们从各自的工作场所招募患者进行研究。有24名使用新实践指南的营养师为患者提供护理的结果数据，以及30名使用更传统方法的营养师为患者提供护理的结果数据。
卡方检验、t检验和协方差分析。
实践指南组的营养师与患者相处的时间比常规护理组的营养师多63%，并且比常规护理组的营养师更有可能进行评估并与患者讨论结果。实践指南组的营养师更关注血糖控制目标。3个月时，实践指南组21名（88%）患者的HbA1c水平有所改善，而常规护理组为16名（53%）。实践指南组患者的HbA1c水平降幅大于常规护理组患者（-1.00对-0.33）。这种差异具有统计学意义且具有临床意义。
结论/应用：营养师对1型糖尿病实践指南反应积极。与常规护理相比，使用指南导致营养师的实践发生变化，并在3个月时使患者血糖结果有更大改善。实践指南对患者对护理的满意度或对生活质量的感知质量没有显著影响。
