强化教育对糖尿病患者低血糖症发生率的影响

目的探讨强化教育对糖尿病（DM）患者遵医行为及低血糖症发生率的影响。方法将153例DM患者随机分为强化教育组78例和普通教育组75例。普通教育组进行普通DM健康教育，强化教育组采取针对性强化教育，提高患者对低血糖症相关知识的了解和自护技能的掌握。干预1年后评价效果。结果强化教育组低血糖发生率、低血糖防治相关知识得分、遵医依从性显著优于普通教育组（均P〈0．01）。结论与普通健康教育相比较，强化教育可显著提高DM患者遵医依从性，降低低血糖症发生率。     

强化教育与随访对2型糖尿病患者生活质量的影响

目的探讨强化教育及强化随访对2型糖尿病患者生活质量的影响。方法将120例2型糖尿病患者按入院时间分为强化组和对照组各60例,强化组采用强化教育及强化随访,对照组采用传统健康教育。于入组时和出院后6个月、12个月,测量两组患者的糖化血红蛋白(HbA1c)值;采用2型糖尿病患者生活质量评定量表(DMQLS)评定两组患者的生活质量。结果两组干预后的HbA1c值、生活质量评分显著优于入组时(均P0.05);强化组HbA1c值、生活质量评分显著优于对照组(均P0.05)。结论强化教育及强化随访较传统健康教育更有效地控制2型糖尿病患者的血糖水平,提高患者的生活质量。     

对糖尿病患者实施小班式强化教育效果探讨

目的探讨针对2型糖尿病患者的有效健康教育方法。方法将自愿参加小班式强化教育（下称小班教育）的120例2型糖尿病患者作为观察组，按匹配原则选取同期接受常规健康教育的65例2型糖尿病患者作为对照组。观察组每个班限定患者10～15例，每次90min，其中中场休息或课间运动操30min，每周1次，24次为1个循环周期（6个月），患者可中途参加；培训内容包括糖尿病知识讲座、咨询答疑和自护技能操作训练。小班教育前及教育6个月后评价效果。结果观察组糖尿病知识掌握达标率和自护能力达标率显著高于小班教育前（均P〈0．01），FPG、2hPG及HbAlc控制水平显著优于对照组（P〈0．05，P〈0．01）。结论采取小班式强化教育可显著提高2型糖尿病患者的健康教育效果。     

对糖尿病患者实施小班式强化教育效果探讨

目的探讨针对2型糖尿病患者的有效健康教育方法。方法将自愿参加小班式强化教育(下称小班教育)的120例2型糖尿病患者作为观察组,按匹配原则选取同期接受常规健康教育的65例2型糖尿病患者作为对照组。观察组每个班限定患者10～15例,每次90min,其中中场休息或课间运动操30min,每周1次,24次为1个循环周期(6个月),患者可中途参加;培训内容包括糖尿病知识讲座、咨询答疑和自护技能操作训练。小班教育前及教育6个月后评价效果。结果观察组糖尿病知识掌握达标率和自护能力达标率显著高于小班教育前(均P0.01),FPG、2hPG及HbAlc控制水平显著优于对照组(P0.05,P0.01)。结论采取小班式强化教育可显著提高2型糖尿病患者的健康教育效果。     

家庭强化教育对农村糖尿病患者治疗依从性的影响

目的 提高农村糖尿病患者治疗依从性及治疗效果.方法 将187例农村糖尿病患者按住院时间分为对照组(91例)和实验组(96例).对照组按传统的糖尿病健康教育方法 实施教育;实验组在住院过程实施家庭强化教育.观察两组治疗依从性及血糖控制情况.结果 出院后半年,两组饮食疗法、胰岛素注射、自我监测、运动疗法、定期复查依从性为23.1%～77.1%,实验组治疗依从性显著高于对照组(均P＜0.01);其空腹血糖、餐后2 h血糖及HbAlc控制良好率显著高于对照组,低血糖发生率显著低于对照组(均P＜0.01).结论 农村糖尿病患者的治疗依从性偏低,说明医院内的健康教育对农村糖尿病患者治疗的影响有限,应在农村基层建立有效的糖尿病患者教育管理网,家庭强化教育能提高农村糖尿病患者治疗依从性,有利于疾病控制.     

家庭强化教育对农村糖尿病患者治疗依从性的影响

目的提高农村糖尿病患者治疗依从性及治疗效果。方法将187例农村糖尿病患者按住院时间分为对照组（91例）和实验组（96例）。对照组按传统的糖尿病健康教育方法实施教育;实验组在住院过程实施家庭强化教育。观察两组治疗依从性及血糖控制情况。结果出院后半年,两组饮食疗法、胰岛素注射、自我监测、运动疗法、定期复查依从性为23．1％～77．1％,实验组治疗依从性显著高于对照组（均P〈O．01）;其空腹血糖、餐后2h血糖及HbAlc控制良好率显著高于对照组,低血糖发生率显著低于对照组（均P＜O．01）。结论农村糖尿病患者的治疗依从性偏低,说明医院内的健康教育对农村糖尿病患者治疗的影响有限,应在农村基层建立有效的糖尿病患者教育管理网,家庭强化教育能提高农村糖尿病患者治疗依从性,有利于痰病控制。     

社区强化饮食教育对糖尿病患者饮食依从性的影响

目的探讨社区强化饮食教育对糖尿病患者饮食治疗依从性的影响,为进一步探讨糖尿病健康教育模式提供依据。方法将283例住院糖尿病患者随机分为观察组（145例）和对照组（138例）,两组住院期间接受糖尿病常规健康教育,观察组在常规健康教育基础上,出院后实施延伸护理服务,在社区继续实施强化饮食教育。采用量表评定两组患者干预前后糖尿病饮食认知状况及饮食治疗依从性。结果干预3个月后观察组糖尿病饮食认知评分及饮食治疗依从性评分显著高于对照组（P〈0．05,P〈0．01）。结论将强化饮食教育延伸至社区,可以有效提高糖尿病患者饮食认知水平,提高其饮食治疗的依从性。     

社区强化饮食教育对糖尿病患者饮食依从性的影响

目的 探讨社区强化饮食教育对糖尿病患者饮食治疗依从性的影响,为进一步探讨糖尿病健康教育模式提供依据.方法 将283例住院糖尿病患者随机分为观察组(145例)和对照组(138例),两组住院期间接受糖尿病常规健康教育,观察组在常规健康教育基础上,出院后实施延伸护理服务,在社区继续实施强化饮食教育.采用量表评定两组患者干预前后糖尿病饮食认知状况及饮食治疗依从性.结果 干预3个月后观察组糖尿病饮食认知评分及饮食治疗依从性评分显著高于对照组(P＜0.05,P＜0.01).结论 将强化饮食教育延伸至社区,可以有效提高糖尿病患者饮食认知水平,提高其饮食治疗的依从性.     

初次诊断2型糖尿病患者的早期强化教育护理体会

目的:通过早期强化教育,普及糖尿病患者的健康知识,使初诊断2型糖尿病患者更好地进行自我管理,控制血糖,从而减少或延缓并发症的发生。方法:我科对初诊断2型糖尿病患者通过个育;发放健康知识手册;科内小讲课及出院后知识讲座等方式,实施综合的,连续的早期强化教育。结果:对入选的136例患者,跟踪调查结果显示,经过早期强化教育,患者掌握控制疾病的知识和技巧,提高自我管理的能力。结论:初次诊断2型糖尿病早期强化教育,可很好地控制疾病的发展,是减少或延缓并发症的发生的关键。     

糖尿病患者低血糖反应首发症状及相关因素探讨

目的探讨糖尿病患者发生低血糖反应的首发症状、血糖值的范围及最集中的时间段.方法记录每例患者低血糖反应时的症状、血糖值、发生时间及处理措施.结果最常见的首发症状是心慌、出汗;午餐前后是发生低血糖反应最为集中的时间;70.59%患者发生低血糖反应时的血糖值为2.10～3.90 mmol/L.结论糖尿病患者主诉心慌、出汗时,提示发生低血糖的可能,条件允许时立刻监测血糖;对于血糖值＞2.10 mmol/L者仅需进食含糖食品即可缓解症状;午餐前后勤巡视病房;注重加强糖尿病患者及家属的健康教育;以保证一旦发生低血糖时能及时应对.     

对糖尿病患者实施针对性健康教育效果观察

将180例2型糖尿病患者随机分为观察组与对照组各90例。对照组实施常规健康教育,观察组在此基础上 评估糖尿病相关知识需求,进行针对性授课并演示操作,让患者重复操作及提问方式考核其知识掌握程度并定期 随访。观察两组患者入院、出院时及出院8个月末血糖控制情况、体重指数、运动及尿糖监测情况。结果出院8个 月末观察组与对照组患者的血糖、甘油三酯及每周运动次数比较,差异有显著性意义(均P<0.05)。提示健康教 育评估在糖尿病教育中起重要作用,出院后继续教育、定期随访对巩固健康教育效果有重要意义。     

Effects of Intensive Therapy and Antecedent Hypoglycemia on Counterregulatory Responses to Hypoglycemia in Type 2 Diabetes

OBJECTIVE—The physiology of counterregulatory responses during hypoglycemia in intensively treated type 2 diabetic subjects is largely unknown. Therefore, the specific aims of the study tested the hypothesis that 1) 6 months of intensive therapy to lower A1C <7.0% would blunt autonomic nervous system (ANS) responses to hypoglycemia, and 2) antecedent hypoglycemia will result in counterregulatory failure during subsequent hypoglycemia in patients with suboptimal and good glycemic control.RESEARCH DESIGN AND METHODS—Fifteen type 2 diabetic patients (8 men/7 women) underwent 6-month combination therapy of metformin, glipizide XL, and acarbose to lower A1C to 6.7% and 2-day repeated hypoglycemic clamp studies before and after intensive therapy. A control group of eight nondiabetic subjects participated in a single 2-day repeated hypoglycemic clamp study.RESULTS—Six-month therapy reduced A1C from 10.2 ± 0.5 to 6.7 ± 0.3%. Rates of hypoglycemia increased to 3.2 episodes per patient/month by study end. Hypoglycemia (3.3 ± 0.1 mmol/l) and insulinemia (1,722 ± 198 pmol/l) were similar during all clamp studies. Intensive therapy reduced (P < 0.05) ANS and metabolic counterregulatory responses during hypoglycemia. Antecedent hypoglycemia produced widespread blunting (P < 0.05) of neuroendocrine, ANS, and metabolic counterregulatory responses during subsequent hypoglycemia before and after intensive therapy in type 2 diabetic patients and in nondiabetic control subjects.CONCLUSIONS—Intensive oral combination therapy and antecedent hypoglycemia both blunt physiological defenses against subsequent hypoglycemia in type 2 diabetes. Prior hypoglycemia of only 3.3 ± 0.1 mmol/l can result in counterregulatory failure in type 2 diabetic patients with suboptimal control and can further impair physiological defenses against hypoglycemia in intensively treated type 2 diabetes.Large randomized controlled multicenter clinical trials have demonstrated the benefit of improved glycemic control on microvascular complications in both type 1 and type 2 diabetes (1,2). These compelling data have produced a paradigm shift in the treatment of diabetes (particularly type 2 diabetes) striving for A1C values <7.0% (3). The major drawbacks of tight metabolic control in patients with type 1 diabetes are well documented and include increased hypoglycemia and weight gain (4–8).Recently, three large studies have investigated the effects of rigorous metabolic control (A1C <7.0%) on the prevalence of macrovascular disease in type 2 diabetes (9–11). The overall conclusion of these studies was that A1C values <7.0% did not produce a statistically significant reduction in macrovascular events but did produce a marked increase in hypoglycemia in type 2 diabetes. The effects of intensive therapy on physiological counterregulatory responses during hypoglycemia in type 2 diabetes have not been thoroughly investigated. Burge et al. (12) demonstrated that improving glycemic control during an 8-day in-patient admission could lower symptom responses and plasma glucose levels for activation of epinephrine during hypoglycemia. Levy et al. (13), using a cross-sectional study design, also concluded that improved glycemic control in type 2 diabetes shifts the thresholds for counterregulatory hormone release to lower plasma glucose concentrations during hypoglycemia. Korzon-Burakowska et al. (14) improved A1C from 11.3 ± 1.1 to 8.1 ± 0.9% during a 4-month period. Thresholds (i.e., plasma glucose values) for counterregulatory hormone release and epinephrine and cortisol responses were lowered by improved glycemic control. Spyer et al. (15), investigating a group of seven type 2 diabetic patients with an A1C of 7.4%, also found that the glycemic thresholds for counterregulatory hormone release were reduced from elevated to normal physiological glucose levels. However, similar to some (13,16) but not all studies (17), there was no difference in values of the key counterregulatory hormones, epinephrine and glucagon, during hypoglycemia when compared with nondiabetic control subjects. Studies investigating the mechanisms regulating counterregulatory responses during hypoglycemia in type 2 diabetes are even fewer. Segel et al. (16) determined that antecedent hypoglycemia in a group of type 2 diabetic patients with an A1C of 8.1% resulted in hypoglycemia-associated autonomic failure similar to patients with type 1 diabetes. Despite the above data, two questions remain unanswered: 1) What are the effects of a period of rigorous glycemic control to reduce A1C <7.0% on counterregulatory responses in type 2 diabetes, and 2) what are the effects of antecedent hypoglycemia on autonomic nervous system (ANS), neuroendocrine, and metabolic counterregulatory mechanisms before and after a period of rigorous metabolic control in type 2 diabetes? In the present study, we tested the hypothesis that 6-month intensive therapy to lower A1C <7.0% would impair counterregulatory response to hypoglycemia and that antecedent hypoglycemia would further impair key homeostatic counterregulatory mechanisms during subsequent hypoglycemia in type 2 diabetes.     

Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

Background

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score.

Methods

We evaluated the efficacy of LSG (n?=?14) vs. IMT (n?=?17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9?±?5.3kg/m² and target HbA1c?<?7 %. The mean (±SD) age of the patients was 49.6?±?11.9 years and 74 % were women. The mean duration of diabetes was 8.5?±?6.1 years and mean HbA1c was 8.6?±?1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up.

Results

The mean duration of follow-up was 12.5?±?5.0 (median 12) months. EBWL was 61.2?±?17.6 % and 27.4?±?23.6 % in LSG and IMT group respectively (p?<?0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6?±?1.5 % in LSG and 7.1?±?1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT.

Conclusions

In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.     

糖尿病患者鞋袜穿着现状的调查研究

目的了解糖尿病患者鞋袜穿着现状．为促进患者选择和穿着合适鞋袜、预防足溃疡发生提供参考依据。方法采用糖尿病足危险筛查及检查足部和鞋袜的方式．对上海某医院门诊就诊的285例糖尿病患者所穿的鞋袜情况及患者糖尿病足危险情况进行调查。结果仅27例（9．5％）糖尿病患者足部正常;77．2％患者穿危险的鞋．女性穿危险鞋的比例显著高于男性（P〈0．05）。女性患者倾向于穿非棉、袜口过紧的浅色袜子．而79．8％男性穿深色的袜子。结论糖尿病患者鞋袜穿着现状不容乐观．在临床工作中应注重糖尿病患者鞋袜检查和指导．指导患者选择和穿着合适的鞋袜,预防足溃疡的发生。     

2型糖尿病无症状低血糖患者的护理

对2型糖尿病患者采用动态血糖监测系统（CGMS）筛查出无症状低血糖患者46例,并对此类患者加强心理护理,病情观察,严密监测血糖,给予饮食、运动、健康指导。结果患者住院期间未发生严重低血糖反应。提出采取护理干预能有效降低无症状低血糖的发生,提高患者的生活质量。     

2型糖尿病无症状低血糖患者的护理

对2型糖尿病患者采用动态血糖监测系统(CGMS)筛查出无症状低血糖患者46例,并对此类患者加强心理护理,病情观察,严密监测血糖,给予饮食、运动、健康指导.结果患者住院期间未发生严重低血糖反应.提出采取护理干预能有效降低无症状低血糖的发生,提高患者的生活质量.