患者的伴侣一起参与、改善糖尿病控制


  【24drs.com】新研究显示,对于第二型糖尿病控制不佳的成人,纳入他们的配偶或其它承诺参与之伙伴的行为电话访谈,会使结果有所差异。
  
  雪城纽约上州医科大学、州立大学精神病学暨行为科学教授Paula M Trief博士等人进行的此篇随机试验结果,在线发表于7月25日的糖尿病照护期刊。
  
  Trief博士表示,纳入有意愿的伙伴,可以在几个方面有所助益。合作的双方都须同意,介入的目的是帮助他们了解糖尿病对他们本身与他们彼此的关系有何影响。
  
  她表示,这个想法是朝向他们如何展开相互帮助之沟通而努力,而不只是监督功能的教练。
  
  医师或其它医疗保健人员可以询问患者是否想要伙伴参与,以及他们如何共同应对糖尿病与此疾病对他们的影响。
  
  这篇研究是多中心、历时12个月的随机控制试验,共280组,其中一人的第二型糖尿病控制不佳(HbA1c > 7.5%),他们被随机分组到三种介入方式之一,都是由糖尿病卫教师进行电话访谈:行为介入双人通话、行为介入个别通话、个别糖尿病介入通话。
  
  这三组都接到2次初次的75分钟综合糖尿病卫教通话,而教育组这组就没有后续的介入;其它两组各接到另外10次通话,每次约1小时以内。
  
  这两组的行为介入包括目标设定、自我监督、行为承诺与促进饮食改变、运动、药物顺从性、血糖监测。
  
  在伙伴介入这组中,伙伴积极参与通话,并鼓励互相支持改变,使用合作解决问题的技巧,并体认彼此的相互影响,还有两堂重点在于沟通与冲突管理之课程。
  
  三分之二的患者是男性,约三分之一自述为弱势族群,他们的平均年龄为57岁、患有糖尿病的时间为12年,有固定关系25.5年,开始时的平均HbA1c是9.1%。
  
  三组的平均HbA1c都显著降低,整体在任何追踪时间点皆无显著差异。
  
  不过, 对于那些开始时的HbA1c居于三分位中间者—也就是8.3% -9.2%者 —只有伙伴组在1年时 HbA1c 显著降低,从平均8.7%降到8.0% (P < .05)。
  
  开始时的HbA1c低于8.3%者,三个介入组都无改变,而那些开始时的HbA1c大于9.2%者,三个介入组都产生改善。
  
  相较于开始时,只有伙伴组的身体质量指数有些微的显著减少(12个月时,P = 0.021),而伙伴组和糖尿病教育介入组的腰围比开始时显著降低。
  
  不过,个别介入组的收缩压和舒张压实际改善最多(8个月时与教育组相比,收缩压P = 0.021、舒张压P = 0.032)。
  
  但是,伙伴介入组在一些社会心理检测有比较好的结果,例如:糖尿病压力在12个月时显著低于教育组(P = .009),也显著低于开始时(P = .03),另外,伙伴组在8个月时的忧郁症分数也低于开始时(P = .014)。
  
  在对收到的服务程度的满意度这个问题方面, 83.5%的伙伴组、70.3% 的个别介入组、41.3%的教育组表示非常满意。
  
  伙伴组的差异显著高于个别介入组(P = .05),这两组则是显著优于教育组(P < .001)。
  
  Trief博士表示,事实是,HbA1c值最高的患者对于糖尿病卫教的反应影响了结果。
  
  另外,伙伴介入组和可比较之个别介入组的比较方面,肯定是一个挑战,因为任何行为介入都会有很多影响,使它难以厘清两种行为介入的差异。
  
  她观察发现,其它研究大部份使用一般照护作为比较。
  
  这就表示,我认为对居于三分位中间者的影响是相当惊人的,特别是这些人大部份是医师在实务上所诊治的患者。虽然这些讨论要花一点时间,如果可以让伙伴积极配合,它就值得了。
  
  本篇研究接受国家健康研究院(NIH)资助,第一年的资金是由NIH多样性奖学金补助。Trief博士无相关财务关系;其它共同作者的相关宣告列于文中。
  
  资料来源:http://www.24drs.com/
  
  Native link:Involving Patient's Partner May Improve Diabetes Control
  

Involving Patient's Partner May Improve Diabetes Control

By Miriam E Tucker
Medscape Medical News

For adults with poorly controlled type 2 diabetes, a behavioral telephone intervention that includes their spouse or other committed partner may make a difference, new research shows.

Results from the randomized trial were published online July 25 in Diabetes Care by Paula M Trief, PhD, professor of psychiatry and behavioral sciences at State University of New York Upstate Medical University, Syracuse, and colleagues.

"It is likely to be beneficial in several ways to involve partners who are willing.…Both partners need to agree, and the intervention should be aimed at helping them see how diabetes affects each of them and their relationship," Dr Trief told Medscape Medical News.

The idea, she said, is "to strive toward opening up communication about how they can help each other, not for the partner to be a watchdog but to be a supportive coach."

Clinicians or other healthcare workers can ask if the patient would like the partner to participate and how they are working together to address diabetes and its effect on them.

Benefit Seen Among Those With HbA1c 8.3%–9.2%

The study was a multicenter, 12-month, randomized controlled trial involving 280 couples with one partner who had poorly controlled type 2 diabetes (HbA1c > 7.5%). They were randomized to one of three interventions, all delivered by telephone by diabetes educators: behavior-intervention couples calls, behavior-intervention individual calls, or individual diabetes education calls.

All three groups received two initial 75-minute calls of comprehensive diabetes education. In the education group, there was no further intervention.

The other two groups received 10 additional calls each, lasting just under an hour.

The behavioral interventions in both of those groups included goal-setting, self-monitoring, and behavioral contracting and promoted changes in diet, activity, medication adherence, and blood glucose monitoring.

In the couples' intervention, partners were actively involved in the calls and were encouraged to provide mutual support for change, using collaborative problem-solving techniques and recognizing the reciprocal effects each had on the other. Two sessions also focused on communication and conflict management.

Two-thirds of the patient participants were male, and nearly one-third were self-described minorities. They had a mean age of 57 years and diabetes duration of 12 years and had been in the committed relationship for 25.5 years, on average. The mean baseline HbA1c was 9.1%.

Significant reductions in mean HbA1c occurred in all three groups, with no significant differences overall at any follow-up.

However, for those in the middle tertile of baseline HbA1c — 8.3% to 9.2% — HbA1c was significantly lower at 1 year only in the couples group, dropping from a mean of 8.7% to 8.0% (P < .05).

There were no changes in any of the three intervention groups for those with baseline HbA1c below 8.3%, while for those starting with HbA1c above 9.2%, all three interventions produced an improvement.

Other Improvements Seen With the Different Interventions

Compared with baseline, there were small, significant reductions in body mass index only for the couples' intervention (P = 0.021 at 12 months), while both the couples and the diabetes-education interventions significantly reduced waist circumferences compared with baseline.

However, both systolic and diastolic blood pressure actually improved most in the individual intervention group (compared with the education group at 8 months, P = 0.021 for systolic and P = 0.032 for diastolic).

But the couples intervention produced superior results for some psychosocial measures, including significantly lower diabetes distress at 12 months than in the education group (P = .009) and compared with baseline (P = .03). Also, the couples group had reduced depression scores at 8 months compared with baseline (P = .014).

On a questionnaire that asked about "satisfaction with the amount of help received," 83.5% of the couples group, 70.3% of the individual intervention, and 41.3% of the education group reported being "very satisfied."

The differences were significantly higher for the couples group compared with the individual-intervention group (P = .05) and for both of those compared with the education group (P < .001).

The fact that the patients with the highest HbA1c levels responded to diabetes education affected the results, Dr Trief said.

And she noted that the comparison of the couples intervention with a comparable individual intervention "was certainly a challenge, since there's just so much effect any behavioral intervention will have, making it harder to find differences between two behavioral interventions."

Most other studies have used "usual care" as a comparison, she observed.

"That said, I think the effect on the middle-tertile group was quite striking, especially since that's the group most clinicians see in their practices.…While it can take time to have these discussions, if it positively engages the partner it can be worth it."

This study was supported by a National Institutes of Health (NIH) grant, and the first year was funded by a NIH diversity fellowship supplement. Dr Trief has no relevant financial relationships; disclosures for the coauthors are listed in the article.

    
相关报导
单靠筛检与治疗无法预防第二型糖尿病
2017/1/12 上午 11:07:07
别老是坐着 少坐一点对糖尿病有好处
2016/12/9 上午 10:05:25
大麻衍生制剂可能有助于第二型糖尿病
2016/9/21 下午 03:39:06

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页