Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus.
Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus.
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DOI：
10.1111/dme.12744
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Liu A
中科院分区：
文献类型：
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作者：
Gee BT;Nansel TR;Liu A
确定低强度临床综合行为干预是否降低了1型糖尿病儿童低血糖事件的发生率。共有390个1型糖尿病儿童家庭参加了一项为期2年的行为干预随机临床试验。该干预措施旨在通过针对家庭的糖尿病问题解决技能来改善糖尿病管理实践。低血糖事件分为两组：口服治疗组和胃肠外治疗组。事件由参与者在每次诊所访视时自我报告，约每3-4个月进行一次。分析包括双样本t检验、平均累积函数检验和复发事件的考克斯比例风险模型，以比较组间的发生率。在整个2年研究期间，通过口服富含葡萄糖的食物治疗的低血糖事件和需要肠外治疗的事件的发生率在研究条件之间没有显著差异;然而，在参加者登记的第二年，干预组口服治疗的事件发生率为13.6/100人-年，而干预组为27.3/100患者-年。对照组的平均生存时间（P = 0.02）。第二年这些事件的风险比为0.49（95% CI 0.27-0.90; P = 0.02）。我们的研究结果表明，需要长期（> 1年）关注针对年轻人糖尿病管理的干预措施的实施。针对解决问题技能的行为干预可以被认为是减少1型糖尿病青少年低血糖的实用的非药物策略。
To determine if a low-intensity, clinic-integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes. A total of 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family’s diabetes problem-solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self-reported by participants at each clinic visit, which occurred approximately every 3–4 months. Analyses included two-sample t-tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups. Across the entire 2-year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose-rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person-years compared with 27.3 per 100 patient-years in the control group (P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27–0.90; P = 0.02). Our findings suggest the need for a long-term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes.