A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care
A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care
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DOI：
10.2337/diacare.27.3.670
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发表时间：
2004-03-01
期刊：
影响因子：
16.2
通讯作者：
Porta, M
中科院分区：
文献类型：
--
作者：
Trento, M;Passera, P;Porta, M
目的 - 研究与个体护理和教育相比，由团体管理的 2 型糖尿病患者的知识、解决问题的能力和生活质量的时间过程变化。 研究设计和方法 - 我们进行了一项为期 5 年的随机对照临床试验，比较在医院二级护理糖尿病病房中通过团体糖尿病护理与个体糖尿病护理提供的继续系统教育。共有 120 名未接受胰岛素治疗的 2 型糖尿病患者入组，并随机分配至团体或个人护理组。 8 人未开始研究，28 人未完成研究。主要结果指标是糖尿病知识、解决问题的能力、生活质量、HbA(1c)、BMI 和 HDL 胆固醇。 结果：通过团体护理，糖尿病知识和解决问题的能力从第一年开始有所改善，而对照组的情况则恶化（两者 P < 0.001）。团体护理的生活质量从第 2 年开始有所改善，但个人护理的生活质量却恶化 (P < 0.001)。对照受试者的 HbA1c 水平在 5 年内逐渐升高（+1.7%，95% CI 1.1-2.2），但团体护理患者则不然（+0.1%，-0.5 至 0.4），其中 BMI 下降（-1.4，-2.0 至 -0.7），HDL 胆固醇升高（+0.14 mmol/l，0.07-0.22）。结论 - 成人如果接受教育程序和环境，2 型糖尿病患者可以获得特定的知识和有意识的行为。根据他们的需求量身定制。传统的一对一护理虽然按照优化标准提供，但会导致知识、解决问题的能力和生活质量的逐渐恶化。更好的认知和社会心理结果与更有利的临床结果相关。
OBJECTIVE - To study time course changes in knowledge, problem solving ability, and quality of life in patients with type 2 diabetes managed by group compared with individual care and education.RESEARCH DESIGN AND METHODS- We conducted a 5-year randomized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit. There were 120 patients with non-insulin-treated type 2 diabetes enrolled and randomly allocated to group or individual care. Eight did not start and 28 did not complete the study. The main outcome measures were knowledge of diabetes, problem solving ability, quality of life, HbA(1c), BMI, and HDL cholesterol.RESULTS- Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects (P < 0.001 for both). Quality of life improved from year 2 with group care but worsened with individual care (P < 0.001). HbA, level progressively increased over 5 years among control subjects (+1.7%, 95% CI 1.1-2.2) but not group care patients (+0.1%, -0.5 to 0.4), in whom BMI decreased (-1.4, -2.0 to -0.7) and HDL cholesterol increased (+0.14 mmol/l, 0.07-0.22).CONCLUSIONS - Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and settings. tailored to their needs. Traditional one-to-one care, although delivered according to optimized criteria, is associated with progressive deterioration of knowledge, problem solving ability, and quality of life. Better cognitive and psychosocial results are associated with more favorable clinical outcomes.