Effects of self-management training in Type 2 diabetes: a randomized, prospective trial
Effects of self-management training in Type 2 diabetes: a randomized, prospective trial
复制标题
DOI：
10.1111/j.1464-5491.2007.02089.x
复制
发表时间：
2007-04-01
影响因子：
3.5
通讯作者：
Haak, T.
中科院分区：
文献类型：
--
作者：
Kulzer, B.;Hermanns, N.;Haak, T.
目的在随机试验中测试三种教育方案对2型糖尿病患者的疗效。以教学为导向的培训方案(处理A)与小组会议中以自我管理为导向的方案(处理B)进行比较。方法181例2型糖尿病患者(年龄55.6±6.3岁，病程6.6±6.2年，糖化血红蛋白(1c)7.8+/-1.6%，女性49.7%)。结果治疗B组HbA(1c)在t1时持续下降(t08.1+/-1.8%，t17.3+/-1.7%，t27.4+/-1.9%)。在处理A中，HBA(1c)始终保持不变(t0 7.6+/-1.5%，t1 7.5+/-1.3%，t2 7.7+/-1.7%；处理A与处理B；P<；0.05)。治疗C个体化后，HBA(1c)在T1时有所下降，但在T2时下降不明显(t0 7.8+/-1.6%，t1 7.1+/-1.3%，t2 7.6+/-1.6%；治疗B与治疗C比较，P=0.73)。在进一步的医学(体重指数和空腹血糖)、心理(控制、易怒和对进食行为的饥饿依赖、特质焦虑)和行为(运动)变量方面，B组受试者也比A组有显著的益处。两组患者在甘油三酯、高密度脂蛋白、糖尿病相关知识、负性幸福感、尿糖水平、足部护理等方面差异无统计学意义。结论自我管理训练的中期疗效明显高于教导型糖尿病教育。小组会议比更个性化的方法更有效。
Aims The efficacy of three education programmes for Type 2 diabetic patients was tested in a randomized trial. A didactic-oriented training programme (treatment A) was compared with a self-management-oriented programme delivered in group sessions (treatment B). The latter programme was compared with a more individualized approach (treatment C).Methods One hundred and eighty-one Type 2 diabetic patients (age 55.6 +/- 6.3 years, diabetes duration 6.6 +/- 6.2 years, HbA(1c) 7.8 +/- 1.6%, female 49.7%) took part. Efficacy was assessed 3 months (t1) after baseline (t0) and at a follow-up 15 months (t2) after baseline.Results The fall in HbA(1c) in treatment B at t1 was sustained at t2 (t0 8.1 +/- 1.8%, t1 7.3 +/- 1.7%, t2 7.4 +/- 1.9%). In treatment A, HbA(1c) was unchanged throughout (t0 7.6 +/- 1.5%, t1 7.5 +/- 1.3%, t2 7.7 +/- 1.7%; treatment A vs. treatment B; P < 0.05). With the more individualized approach of treatment C, there was a fall in HbA(1c) at t1, but this was not sustained at t2 (t0 7.8 +/- 1.6%, t1 7.1 +/- 1.3%, t2 7.6 +/- 1.6%; treatment B vs. treatment C; P = 0.73). There were also significant benefits in treatment B subjects compared with treatment A in further medical (body mass index and fasting blood glucose), psychological (control, irritability and hunger dependency of eating behaviour, and trait anxiety) and behavioural (exercise) variables. There were no significant benefits of the more individualized treatment C compared with group treatment B. No significant differences were found regarding triglyceride levels, high-density lipoprotein, diabetes-related knowledge, negative well-being, urine or blood glucose levels or foot care.Conclusion Self-management training had a significantly higher medium-term efficacy than didactic diabetes education. The group sessions were more effective than a more individualized approach.