Spanish diabetes self-management with and without automated telephone reinforcement - Two randomized trials
Spanish diabetes self-management with and without automated telephone reinforcement - Two randomized trials
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DOI：
10.2337/dc07-1313
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发表时间：
2008-03-01
期刊：
影响因子：
16.2
通讯作者：
Piette, John D.
中科院分区：
文献类型：
--
作者：
Lorig, Kate;Ritter, Philip L.;Piette, John D.
目的：确定1）西班牙糖尿病自我管理项目（SDSMP）的参与者在6个月时与随机对照受试者相比，是否会表现出健康状况、健康行为和自我效能的改善;和2）是否SDSMP参与者每月接受自动电话加固将保持改善在18个月优于那些没有接受加固。共有567名讲西班牙语的2型糖尿病成年人被随机分配到常规护理对照组或为期6周的基于社区的同行领导的SDSMP。SDSMP参与者被重新随机分配，接受15个月的自动电话留言或没有强化。在基线和6个月及18个月时测量A1 C。所有其他数据通过自填问卷收集。结果-在6个月SDSMP参与者与对照组相比，A1 C（-0.4%），健康困扰，低血糖和高血糖症状，自我效能（P < 0.05）的改善。在18个月时，所有改善持续存在（P < 0.05）。SDSMP参与者还表现出自我评定的健康状况和与医生沟通的改善，急诊室就诊次数减少（6个月内-0.18次，P < 0.05），并且倾向于减少医生就诊次数。在18个月，加强和nonreinforced参与者之间的唯一区别是增加葡萄糖监测的reinforcementgroup.CONCLUSIONS-SDSMP表现出降低A1 C和改善健康状况的有效性。增援并没有增加其效力。鉴于西班牙语人口的高度需求，值得考虑实施《战略发展管理计划》。
OBJECTIVE - To determine 1) whether participants in the Spanish Diabetes Self-Management Program (SDSMP), when compared at 6 months to randomized control subjects, would demonstrate improvements in health status, health behaviors, and self-efficacy; and 2) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement.RESEARCH DESIGN AND METHODS - A total of 567 Spanish-speaking adults with type 2 diabetes were randomized to a usual-care control group or 6-week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated telephone messages or no reinforcement. A1C was measured at baseline and 6 and 18 months. All other data were collected by self-administered questionnaires.RESULTS - At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C (-0.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy (P < 0.05). At 18 months all improvements persisted (P < 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (-0.18 visits in 6 months, P < 0.05), and trended toward fewer visits to physicians. At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group.CONCLUSIONS- The SDSMP demonstrated effectiveness in lowering A1C and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation.