Diabetes education and care management significantly improve patient outcomes in the dialysis unit
Diabetes education and care management significantly improve patient outcomes in the dialysis unit
复制标题
DOI：
10.1053/ajkd.2002.34915
复制
发表时间：
2002-09-01
影响因子：
13.2
通讯作者：
McDougall, K
中科院分区：
文献类型：
--
作者：
McMurray, SD;Johnson, G;McDougall, K
背景糖尿病的发病率，特别是2型糖尿病，在一般人群中正在增加。同样，在透析机构中，糖尿病患者发生终末期肾病的发生率也随之增加，以糖尿病作为主要诊断开始透析治疗的患者中有44%。本研究的目的是确定糖尿病的强化教育和护理管理是否可以改善血糖控制，改变患者的行为，并减少透析室的并发症。方法：83例患者根据透析治疗日分为对照组和研究组。所有患者均随访一年。研究组的患者接受糖尿病教育计划，并由护理经理进行随访，护理经理提供自我管理教育，糖尿病自我护理监测/管理，动机指导和足部检查。结果：对照组基线足部风险分类从2.7恶化到3.3（P < 0.05），而研究组没有变化（2.2到2.0）。研究组无截肢，对照组5例截肢（P < 0.05）。对照组有10例患者因糖尿病或血管相关入院，而研究组有1例患者因糖尿病或血管相关入院（P < 0.002）。血红蛋白A，研究组从6.9下降到6.3，而对照组的结果没有变化（P < 0.005）。糖尿病相关的生活质量评分在研究组从76增加到86（与对照组相比P < 0.001）。与对照组相比，研究组在所有六个方面的自我管理行为都有显着改善。美国糖尿病协会认可透析中心提供糖尿病教育。结论：在透析室实施强化糖尿病教育和护理管理计划可有效改善患者结局、血糖控制和改善糖尿病患者的生活质量。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background. The incidence of diabetes mellitus, particularly type 2, is increasing in the general population. Similarly, the incidence of patients with diabetes mellitus who develop end-stage renal disease has increased concomitantly in the dialysis facility to 44% of patients starting dialysis therapy with diabetes mellitus as their primary diagnosis. The aim of this study is to determine whether intensive education and care management of diabetes could improve glycemic control, alter patient behavior, and reduce complications in the setting of the dialysis unit. Methods: Eighty-three patients were allocated to either the control group or study group based on their day of dialysis treatment. All patients were followed up for a year. Patients in the study group underwent a diabetes education program and were followed up by a care manager who provided self-management education, diabetes self-care monitoring/management, motivational coaching, and foot checks. Results: The control group baseline foot risk category worsened from 2.7 to 3.3 (P < 0.05), whereas it was unchanged in the study group (2.2 to 2.0). There were no amputations in the study group versus five amputations in the control group (P < 0.05). Ten patients in the control group were hospitalized with diabetes- or vascular-related admissions versus one patient in the study group (P < 0.002). Hemoglobin A,. levels declined from 6.9 to 6.3 in the study group, whereas results of the control group were unchanged (P < 0.005). Diabetes-related quality-of-life scores increased in the study group from 76 to 86 (P < 0.001 versus the control group). There was a significant improvement in self-management behavior in all six categories evaluated in the study group versus the control group. Dialysis centers were recognized by the American Diabetes Association to provide diabetes education. Conclusion: A program of intensive diabetes education and care management in a dialysis unit is effective in providing significant improvements in patient outcomes, glycemic control, and better quality of life in patients with diabetes mellitus. (C) 2002 by the National Kidney Foundation, Inc.