胰岛素使用访谈工具对老年糖尿病患者健康素养与预后的影响

目的探讨胰岛素使用访谈工具对老年糖尿病患者健康素养与预后的影响。方法选取2018年1月—12月本科室收治的120例老年糖尿病患者为研究对象,根据随机抽样原则分为对照组与观察组,每组各60例。对照组采用常规健康教育方法,观察组在对照组的基础上采用胰岛素使用访谈工具进行健康教育,均干预3个月。干预前后采用糖尿病健康素养调查问卷对两组患者进行测评,比较干预3个月后两组患者的健康素养水平和治疗疗效。结果干预后,观察组的糖尿病健康素养总分及各个维度得分都明显高于对照组,差异有统计学意义(P0.05);观察组的治疗总有效率高于对照组,差异有统计学意义(P0.05)。结论将胰岛素使用访谈工具应用于老年糖尿病患者中,能有效提高患者的健康素养,从而改善患者的治疗疗效,提高患者生活质量。     

胰岛素访谈工具在糖尿病患者健康教育中的应用效果

目的探讨胰岛素访谈工具在糖尿病患者中的应用效果。方法选择本院住院期间首次遵医嘱使用胰岛素的糖尿病患者80例,随机分成对照组40例和观察组40例,对照组采用传统的健康教育,观察组使用胰岛素访谈工具。比较两组接受健康教育前后是否愿意接受胰岛素治疗情况以及对胰岛素知识的知晓情况。结果接受健康教育前两组是否愿意接受胰岛素治疗情况以及对胰岛素知识的知晓情况差异无统计学意义(P0.05),接受健康教育后观察组均优于对照组(P0.05)。结论胰岛素访谈工具可以改善糖尿病患者对胰岛素治疗的认知情况,提高胰岛素治疗依从性。     

胰岛素使用访谈工具在2型糖尿病患者健康教育中的应用效果研究

目的观察胰岛素使用访谈工具在2型糖尿病胰岛素治疗患者健康教育中的应用效果。方法将90例2型糖尿病患者按随机数字表分为观察组44例和对照组46例。观察组采用胰岛素使用访谈工具进行健康教育,对照组采用传统健康教育方法。入院当天及出院前1 d对患者进行我对胰岛素的看法自评量表调查,出院前1 d对患者进行护理服务满意度调查,出院3个月后门诊检查患者空腹血糖、餐后2 h血糖、糖化血红蛋白。结果我对胰岛素看法评分,干预前观察组和对照组比较差异无统计学意义(P0.05),出院时观察组评分明显优于对照组,两组比较差异有统计学意义(P0.01);观察组患者的满意度明显高于对照组(P0.05);患者出院3个月后,观察组血糖及糖化血红蛋白的指标控制优于对照组。结论胰岛素使用访谈工具的应用既可以提高患者对注射胰岛素治疗的认知,增强患者对使用胰岛素的依从性,提高患者的满意度,也良好的控制了血糖及糖化血红蛋白。     

应用胰岛素使用访谈工具对糖尿病患者血糖控制的效果研究

目的观察胰岛素使用访谈工具对糖尿病患者血糖控制的效果。方法选择200例初次使用胰岛素注射治疗的2型糖尿病患者,按随机数字表分为观察组与对照组各100例。在正规糖尿病治疗基础上,应用胰岛素使用访谈工具对观察组患者进行健康教育,对照组患者接受传统健康教育。记录两组患者在干预前、干预后3个月、干预后6个月的空腹血糖、餐后2h血糖、糖化血红蛋白检测值,比较两组患者低血糖发生率及胰岛素注射部位情况。结果观察组低血糖发生率低于对照组(P0.05),观察组胰岛素注射部位红肿、硬结、肌肉萎缩的发生率低于对照组(P0.05)。治疗前两组患者空腹血糖、餐后2h血糖、糖化血红蛋白检测值差异无统计学意义;干预后观察组患者各时间点的空腹血糖、餐后2h血糖、糖化血红蛋白检测值明显低于对照组(P0.05)。结论应用胰岛素使用访谈工具进行健康教育有助于糖尿病患者的血糖控制。     

规范化教育联合反馈式教育对糖尿病住院患者胰岛素注射的指导作用

目的探讨规范化教育联合反馈式教育方法对糖尿病住院患者胰岛素注射的指导作用。方法 100例糖尿病住院患者随机分为常规组和实验组,各50例。常规组给予规范化胰岛素注射常规教育和培训,实验组在对照组基础上联合反馈式教育。比较2组干预前后健康知识问卷调查得分和干预后糖尿病复发率。结果干预后,2组健康知识问卷调查得分均高于干预前,差异有统计学意义(P0.05),实验组得分高于常规组,差异有统计学意义(P0.05);实验组糖尿病复发率0.0%(0/50),低于常规组的16.0%(8/50),差异有统计学意义(P0.01)。结论在糖尿病患者胰岛素注射中采用规范化教育联合反馈式教育,可有效提高患者注射知识水平,降低糖尿病复发率。     

胰岛素访谈工具干预在社区2型糖尿病患者中的应用

目的:探讨胰岛素访谈工具干预在社区2型糖尿病患者中的应用效果。方法:将120例社区2型糖尿病患者随机分为观察组和对照组各60例,观察组接受为期2个月的糖尿病访谈工具干预,对照组不给予特殊措施。比较干预前后两组血糖指标和患者对胰岛素治疗坚持程度。结果:观察组干预后血糖低于干预前和对照组同期水平(P0.05),两组对胰岛素治疗的坚持程度比较差异有统计学意义(P0.05)。结论:胰岛素访谈工具可以提高社区2型糖尿病患者胰岛素治疗的效果和胰岛素治疗的坚持程度。     

不同年资护士使用胰岛素工具包进行健康教育对糖尿病患者的影响

目的:探讨不同年资护士使用胰岛素工具包对2型糖尿病患者进行健康教育的效果。方法:选择2013年1月~2015年1月我院门诊治疗的100例自行注射胰岛素的糖尿病患者,随机将患者等分为观察组和对照组,观察组患者由工作≥10年的高年资护士使用访谈工具包进行健康教育;对照组患者由工作5年的低年资护士使用访谈工具包进行健康教育。比较不同年资的护理人员对2型糖尿病患者的健康教育效果。结果:干预后两组患者空腹血糖、餐后2 h血糖比较,差异有统计学意义(P0.05);两组患者Hb A1C达标例数比较差异具有统计学意义(P0.05)。结论:高年资护士使用胰岛素工具包对糖尿病患者进行健康教育的效果优于低年资护士,应当加大对低年资护理人员的业务学习培训。     

健康教育对初次应用胰岛素治疗的Ⅱ型糖尿病患者的影响

目的探讨健康教育对初次应用胰岛素治疗的糖尿病患者在疾病知识掌握情况、心理状况及血糖控制等方面的影响。方法 30例初次使用胰岛素治疗的患者接受护士的健康教育。结果前后数据对比知识掌握方面评分P〈0.05、血糖指标变化P〈0.05、遵医行为改变P〈0.05,差异有统计学意义。结论通过健康教育可提高患者知识认知程度,有助于调节心理状态、提高治疗效果,对控制血糖是个切实有效的措施。     

应用胰岛素使用访谈工具提高护生健康教育能力的探讨

目的 探讨胰岛素使用访谈工具在提高护生健康教育能力过程中的应用效果.方法 将70名护生随机分成观察组和对照组各35名.观察组利用胰岛素使用访谈工具对糖尿病患者进行健康教育;对照组采用传统的个体化健康教育方式.分析2组护生对教学的满意度、健康教育能力、理论知识成绩、患者对2组护生的满意度.结果 观察组的考核成绩、对教学方法的满意度、健康教育能力、患者的满意度均高于对照组,2组比较差异有统计学意义.结论 将胰岛素使用访谈工具运用于护生健康教育能力的培养中,可降低健康教育的难度,提高护生的兴趣、自信心、价值感和沟通技巧,从而提高带教质量.     

动机访谈在糖尿病心理性胰岛素抵抗患者中的效果研究

目的:探讨动机访谈在糖尿病心理性胰岛素抵抗患者中的应用效果。方法:选择2015年9月~2016年2月入住我院内分泌科因病情需要注射胰岛素而存在心理性胰岛素抵抗的2型糖尿病患者111例,随机分为对照组55例和试验组56例,对照组住院期间采用常规健康教育,出院后常规电话随访,试验组住院期间采用动机访谈健康教育,出院后电话随访采用动机访谈技术,比较两组患者出院时和出院后6个月心理性胰岛素抵抗诊断量表"我对胰岛素看法"主表得分情况和血糖控制状况、出院后6个月复查次数、胰岛素停用情况。结果:出院后6个月,试验组心理性胰岛素抵抗减轻程度、血糖及糖化血红蛋白控制情况、复查次数及胰岛素停用情况均优于对照组(P0.05),两组比较差异均有统计学意义。结论:动机访谈可有效减轻糖尿病患者心理性胰岛素抵抗,提高出院后治疗效果和遵医行为。     

The human insulin analogue insulin lispro

Insulin lispro is a newly developed analogue of human insulin where the positions of the amino acids lysine and proline have been switched at the end of the B chain of the insulin molecule. Insulin lispro with lysine at position B28 and proline at position B29 has a weaker tendency for self-association than human insulin. This leads to three major differences in the pharmacokinetics: the action begins faster, has a higher peak and the duration is shorter than with human insulin. Thus, insulin lispro has a more precise action profile for the mealtime than human regular insulin. Insulin lispro is recommended to be injected within 15 min before the meal in contrast to 30–40 min for human insulin. In clinical trials with insulin lispro, the postprandial rise of blood glucose is smaller, the rate of hypoglycaemia is lower particularly at night-time, the need for snacks is smaller and the patient preference is better than with human insulin. The long-term control as reflected by an improvement in the HbA_]c level is better with insulin lispro than with human regular insulin, provided that an appropriate basal insulin regimen is used to take into account the shorter duration of action. A few patients have been described who have a severe resistance to human insulin but who have been succesfully treated with insulin lispro. Insulin lispro was designed to be used as a mealtime insulin, and it is a step forward in the treatment of diabetic patients using a basal-bolus insulin regimen.     

Inhaled insulin (pulmonary administered insulin)]

The first report according to Inhaled insulin came out in 1924. Recent clinical trials of inhaled insulin made a real story to insulin-treated diabetic patients. Among some companies, insulin preparation of Pfizer company group consists of dry insulin dispersed by aerosol into particles sufficiently fine to drift into the distal twigs of the respiratory tree. Skylar et al in 2001 reported a randomized proof-of-concept study of inhaled insulin in type 1 diabetes mellitus. The result showed the same efficacy to the same time injections of regular insulin. Other reports showed the efficacy of inhaled insulin comparable to that of lispro insulin and the same action to not only type 1 but also type 2 diabetic patients.     

Changes in insulin resistance with long-term insulin therapy

Thirteen newly diagnosed diabetic subjects, 5 with insulin-dependent diabetes mellitus (IDDM) and 8 with non-insulin-dependent diabetes mellitus, mean age 37.1 yr (range 25-64 yr), underwent glucose-clamp studies at diagnosis of diabetes at plasma glucose 200 mg/dl. Each subject was then treated twice daily with insulin for 6 mo with improvement in glycemic control, and the glucose-clamp studies repeated. Changes in glucose uptake at an insulin infusion rate of 1.0 mU X kg-1 X min-1 varied greatly from diagnosis to 6 mo. There were significant negative correlations between change in glucose uptake and diabetes type (r = -.78, P less than .002), C-peptide secretion (r = -.66, P less than .05), and age (r = -.62, P less than .05). At an insulin infusion rate of 10 mU X kg-1 X min-1 there was improvement in glucose uptake from diagnosis to 6 mo that did not reach statistical significance. During the steady-state periods of the glucose-clamp studies at diagnosis, growth hormone (GH) rose above basal, which reached statistical significance at the higher insulin infusion rate. This increase in GH was not apparent at the time of the glucose-clamp studies after insulin therapy. Our results indicate that in the clinical situation, only patients with IDDM can expect an improvement in their sensitivity to physiologic insulin levels with long-term insulin therapy. In all subjects, improvement in glycemic control leads to abolition of GH secretion in the presence of hyperglycemia.     

Comparison of an insulin analog,insulin aspart,and regular human insulin with no insulin in gestational diabetes mellitus

OBJECTIVE: To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. RESEARCH DESIGN AND METHODS: The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. RESULTS: The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg. h. dl(-1); P = 0.018), but not with regular insulin (30.2 mg. h. dl(-1); P = 0.997), than with no insulin (29.4 mg. h. dl(-1)). CONCLUSIONS: This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.     

Intensive insulin therapy with insulin lispro: a randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection

OBJECTIVE: To evaluate glycemic control, hypoglycemic events, and quality of life in patients treated with continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injection (MDI), with insulin lispro as the principal insulin. RESEARCH DESIGN AND METHODS: This clinical trial enrolled 27 patients with type 1 diabetes. They were randomly assigned to CSII (n = 13) or MDI (n = 14) treatment regimens. Glycemic control (HbA(1c) level) was the primary outcome and was measured monthly for 9 months. Secondary outcomes were patient reports of hypoglycemic events (recorded monthly for 9 months) and quality of life assessed at 9 months using the Diabetes Quality of Life (DQOL) questionnaire. RESULTS: A significant decrease in HbA(1c) from baseline was shown for both groups. However, the overall treatment effect (CSII - MDI) for HbA(1c) was +0.08% (95% CI -0.23 to +0.39, P > 0.10). This was significantly less than the a priori limit of +/-0.5% (P = 0.004). The relative treatment effect ([CSII - MDI]/MDI) for the overall number of hypoglycemic events was +9% (95% CI -37 to +87, P > 0.10). There were no statistically significant differences between treatment groups for any of the DQOL subscales. CONCLUSIONS: No statistically significant differences in glycemic control, reported hypoglycemic events, or quality of life were found in this study. Furthermore, a clinically significant difference of more than +/-0.5% HbA(1c) between the two regimens can be confidently ruled out. We conclude that the choice of intensive insulin therapy should be a matter of patient preference, consistent with lifestyle.     

Human insulin

Human insulin may be advantageous for certain subsets of patients, such as those with gestational diabetes and those who need insulin only during stress or surgery. To date, there is no evidence to support the use of human insulin in diabetics who are doing well on older insulin preparations.