Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial
Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial
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DOI：
10.2337/dc18-1985
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发表时间：
2019-05-01
期刊：
影响因子：
16.2
通讯作者：
Goulden, Peter A.
中科院分区：
文献类型：
--
作者：
McElfish, Pearl A.;Long, Christopher R.;Goulden, Peter A.
目的马绍尔群岛成年人2型糖尿病的发病率很高。以前的糖尿病自我管理教育（DSME）干预马绍尔群岛是不成功的。这项研究比较了两种DSME干预措施改善血糖控制的程度，根据糖化血红蛋白（HbA（1c））的变化进行测量。研究设计和方法：一项两组随机对照试验，比较了标准模式DSME（标准DSME）和文化适应的家庭模式DSME（适应DSME）。马绍尔成年2型糖尿病患者（n = 221）在社区环境中接受标准DSME（n = 111）或在家庭环境中接受适应性DSME（n = 110）。在基线、干预后立即、干预后6个月和12个月评估结果指标，并采用调整后的线性混合效应回归模型进行检查。结果：适应DSME组的受试者显示平均HbA（1c）立即显著下降，（-0.61% [95% CI-1.19，-0.03]; P = 0.038）和12个月（-0.77% [95% CI-1.38，-0.17]; P = 0.013）。在适应性DSME组中，从基线到干预后即刻，参与者的平均HbA（1c）显著降低（-1.18% [95% CI-1.55，-0.81]）、6个月（-0.67% [95% CI-1.06，-0.28]）和12个月（-0.87% [95% CI-1.28，-0.46]）（全部P < 0.001）。标准DSME组受试者的平均HbA（1c）从基线至干预后即刻显著降低（-0.55% [95% CI-0.93，-0.17]; P = 0.005）。结论：接受适应性DSME的参与者在干预后即刻和干预后12个月的平均HbA（1c）下降幅度明显大于接受标准DSME的参与者。这项研究增加了研究的主体，显示了包括参与者家庭成员在内的文化适应性DSME的潜在有效性。
OBJECTIVE Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA(1c)). RESEARCH DESIGN AND METHODS A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. RESULTS Participants in the adapted DSME arm showed significantly greater declines in mean HbA(1c) immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA(1c) from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA(1c) from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005). CONCLUSIONS Participants receiving the adapted DSME showed significantly greater reductions in mean HbA(1c) immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.