家庭健康管理对社区2型糖尿病患者服药依从性影响的研究

目的 探讨家庭健康管理对社区2型糖尿病服药依从性的影响.方法 居住在上海市青浦区徐泾镇徐安居委豪都小区符合WHO诊断标准已确诊为2型糖尿病患者123例,年龄50～75岁,其中男性60例,女性63例,平均年龄（63.9±6.9）岁,病程（10.0±7.4）年,建立家庭健康档案、制定个性化家庭健康管理措施,进行为期2年的干预,对干预前后患者的服药依从性,以及血压、血糖、血脂控制情况进行评估.结果 123例2型糖尿病患者干预后服药依从率（77.1％,94/122,干预期间死亡1例）高于干预前（62.6％,77/123）,差异有统计学意义（x2=6.06,P＜0.05）.干预后血压达标率（51.6％,63/122）,血糖达标率（44.3％,54/122）,总胆固醇达标率（72.1％,88/122）,三酰甘油达标率（61.5％,75/122）,低密度脂蛋白达标率（75.4％,92/122）均高于干预前[血压达标率36.6％ （45/123）,血糖达标率28.5％（35/123）,总胆固醇达标率59.3％（73/123）,三酰甘油达标率47.9％（59/123）,低密度脂蛋白达标率65.0％ （80/123）],干预前后比较差异有统计学意义（x2值分别为5.63、6.61、4.44、4.51、3.97,P均＜0.05）.结论 社区家庭健康管理可以提高2型糖尿病患者的服药依从性,提高血压、血糖、血脂达标率.     

The epidemiology of lifestyle and risk for type 2 diabetes

Results from ecological and migration studies indicate that a western lifestyle is associated with a higher prevalence of type 2 diabetes. In recent years, there has been a rapid accumulation of data on lifestyle and risk for type 2 diabetes from studies on an individual level. This article gives an overview of the evidence for the effect of different lifestyle factors on risk for type 2 diabetes and discusses various methodological approaches. Randomized intervention studies have shown that changes in diet and physical activity can protect against type 2 diabetes. Diet and physical activity can affect the development of type 2 diabetes through changes of body fatness, but also through other pathways. Findings from cohort studies and trials with intermediary endpoints have indicated that higher consumption of whole grain products and exchanging unsaturated fat for saturated fat may lower risk for type 2 diabetes. In addition, several new promising hypotheses about diet and the development of type 2 diabetes are currently being investigated. Light to moderate alcohol consumption may also reduce risk for type 2 diabetes, whereas high alcohol consumption and cigarette smoking may increase risk for type 2 diabetes. Prevention of weight gain by balancing energy intake and expenditure is of paramount importance to limit current increases in the prevalence of type 2 diabetes. In addition, other effects of lifestyle may play an important role in reducing risk for type 2 diabetes.     

The impact of type 2 diabetes mellitus on daily functioning.

BACKGROUND: Traditionally, health and the outcomes of medical treatment have been measured in terms of morbidity, incidence or prevalence of disease, or even mortality. This disease model provides an adequate framework for acute illnesses, but for chronic diseases, severity and their effect on everyday functioning are paramount. For chronic diseases, functional health status, as a vital part of quality of life, is now recognized as an important outcome measure of the GP's care. OBJECTIVE: We aimed to assess the impact of type 2 diabetes mellitus on functional health status in Dutch general practice. METHOD: We conducted a cross-sectional study of the functional health status of all patients with type 2 diabetes mellitus under 85 in two general practices, using the Sickness Impact Profile (SIP) and the COOP/WONCA charts. A control group of non-diabetic patients was selected, matched for practice, sex and age. RESULTS: In total, 127 type 2 diabetes mellitus patients and 127 controls participated in the study, the responses being 78 and 70%, respectively. Between these groups the following were significantly different: the SIP subscore Physical, the SIP sum score and the COOP/WONCA scores for physical fitness and overall health. Type 2 diabetes mellitus patients were 2.46 (95% CI 1.5-4.1) times more likely to experience functional impairment. Cardiovascular morbidity (odds ratio 2.5, 95% CI 1.3-4.7), locomotory morbidity (odds ratio 2.6, 95% CI 1.4-5.1) and diabetes itself (odds ratio 1.4, 95% CI 1.1-1.9) were significantly associated with the presence of functional impairment. CONCLUSION: This study demonstrates the impact of type 2 diabetes mellitus on functional status, particularly in relation to cardiovascular morbidity.     

地特胰岛素与瑞格列奈治疗老年2型糖尿病的体会

目的:探讨地特胰岛素+瑞格列奈在老年2型糖尿病中的应用价值.方法:选择老年2型糖尿病病患74例,采用数字抽签的方式将之随机等分成A、B两组.其中,A组联合应用地特胰岛素与瑞格列奈,B组应用预混胰岛素.观察两组用药后相关血糖指标的变化情况,比较低血糖发生率等指标.结果:A组治疗后的2hBG、MACE、FBG与HbAlc指标水平均明显优于B组(P<0.05).A组的低血糖发生率(2.7％)比B组(21.62％)更低(P<0.05).结论:积极对老年2型糖尿病病患施以地特胰岛素+瑞格列奈治疗,有助于促进其血糖水平的降低,提高用药安全性.     

The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults

This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.     

Understanding medication adherence among patients of Turkish descent with type 2 diabetes: a qualitative study

Objectives. To explore perspectives of Turkish migrants with type 2 diabetes mellitus (T2DM) on adherence to oral hypoglycaemic agents (OHA).

Design. In-depth interviews with 21 T2DM patients of Turkish descent recruited from primary care and community sources in Ghent, Belgium, using a theoretical sampling procedure. Analysis was guided by a grounded theory approach, using Nvivo 8.

Results. Respondents reported a multitude of barriers and facilitators of adherence to OHA. Some of these barriers are distinctive for T2DM patients of Turkish descent. Respondents' causal beliefs about stress and the Belgian climate often led to non-adherence during less stressful periods, like summer holidays in Turkey. Some respondents adjusted their medication use to food intake or during Ramadan fasting. Concerns about OHA were the main reason for the widespread use of herbal medicine in this sample. The religious framework used to interpret diabetes led, in combination with feelings of depression, to non-adherence in some respondents while it facilitated medication adherence in others. A potential gender effect with respect to the self-management of OHA was observed. Non-distinctive factors include: beliefs about OHA, polypharmacy, beliefs about the course of diabetes, forgetfulness, the perception of the doctor's medical expertise, feelings of depression and social support.

Conclusion. Health care providers should explore in detail and regularly patients' perspectives on illness beliefs, medication beliefs and their trust in doctors' medical expertise as this will provide useful starting points for promoting medication adherence. Whenever possible health care workers should engage with their patients in therapeutic alliances.     

Screening for type 2 diabetes and dysglycemia

Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.     

Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis

Background

Diabetes self-management education (DSME) can be delivered in many forms. Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other. assess effects of group-based DSME compared to routine treatment on clinical, lifestyle and psychosocial outcomes in type-2 diabetes patients.

Methods

A systematic review with meta-analysis. Computerised bibliographic database were searched up to January 2008 for randomised controlled trials evaluating group-based DSME for adult type-2 diabetics versus routine treatment where the intervention had at least one session and =/>6?months follow-up. At least two reviewers independently extracted data and assessed study quality.

Results

In total 21 studies (26 publications, 2833 participants) were included. Of all the participants 4 out of 10 were male, baseline age was 60?years, BMI 31.6, HbA1c 8.23%, diabetes duration 8?years and 82% used medication. For the main clinical outcomes, HbA1c was significantly reduced at 6?months (0.44% points; P?=?0.0006, 13 studies, 1883 participants), 12?months (0.46% points; P?=?0.001, 11 studies, 1503 participants) and 2?years (0.87% points; P?<?0.00001, 3 studies, 397 participants) and fasting blood glucose levels were also significantly reduced at 12?months (1.26?mmol/l; P?<?0.00001, 5 studies, 690 participants) but not at 6?months. For the main lifestyle outcomes, diabetes knowledge was improved significantly at 6?months (SMD 0.83; P?=?0.00001, 6 studies, 768 participants), 12?months (SMD 0.85; P?<?0.00001, 5 studies, 955 participants) and 2?years (SMD 1.59; P?=?0.03, 2 studies, 355 participants) and self-management skills also improved significantly at 6?months (SMD 0.55; P?=?0.01, 4 studies, 534 participants). For the main psychosocial outcomes, there were significant improvement for empowerment/self-efficacy (SMD 0.28, P?=?0.01, 2 studies, 326 participants) after 6?months. For quality of life no conclusion could be drawn due to high heterogeneity. For the secondary outcomes there were significant improvements in patient satisfaction and body weight at 12?months for the intervention group. There were no differences between the groups in mortality rate, body mass index, blood pressure and lipid profile.

Conclusions

Group-based DSME in people with type 2 diabetes results in improvements in clinical, lifestyle and psychosocial outcomes.     

Community based yoga classes for type 2 diabetes: an exploratory randomised controlled trial

Background  

Yoga is a popular therapy for diabetes but its efficacy is contested. The aim of this study was to explore the feasibility of researching community based yoga classes in Type 2 diabetes with a view to informing the design of a definitive, multi-centre trial     

Holistic versus composite preferences for lifetime treatment sequences for type 2 diabetes.

This study of patient preferences for lifetime treatment sequences for type 2 diabetes had three objectives: to assess the feasibility of obtaining holistic preference assessments using the time-tradeoff (TTO) technique; to compare composite and holistic preference scores for the same lifetime treatment paths; and to assess the validity of composite and holistic preference measures in terms of their congruence with an individual's rank-order preferences. 101 persons with type 2 diabetes provided preference ratings for hyperglycemic treatments lasting 30 years, including eight discrete treatment states and four treatment paths. Scenarios described drug and glucose-testing regimens, efficacy of glucose control, and side effects. After ranking and rating scenarios on a thermometer scale, subjects provided TTO preferences for each treatment state or path scenario. Holistic assessment of treatment paths was feasible with the TTO technique, in terms of useable data (88% of interviews) and effect on coefficients of variation. Holistic and composite preference scores were not statistically different. Agreement was poor between rankings implied by holistic and composite scores and direct rankings. The authors conclude that lifetime treatment paths with minor differences in health effects can be assessed using either composite (QALY) or holistic (HYE) measures. The validity of these TTO-based preference measures remains unknown.     

江苏省2型糖尿病患者药物治疗方法与血糖控制关系

目的 了解江苏省2型糖尿病（T2DM）患者药物治疗方法与血糖控制的关系,为T2DM的预防控制提供参考依据。方法 于2013年12月-2014年1月,采用整群随机抽样方法在江苏省常熟市和淮安市淮安区、清河区抽取纳入基本公共卫生服务且采取药物治疗措施的15 037例T2DM患者进行问卷调查、体格检查和实验室检测。结果 江苏省15 037例T2DM患者中,单用口服药治疗者12 318例（81.9%）,单用胰岛素治疗者1 728例（11.5%）,口服药联合胰岛素治疗者991例（6.6%）;不同特征T2DM患者药物治疗方法比较,不同性别、文化程度、婚姻状况、地区、居住地、吸烟、饮酒、糖尿病病程、体质指数（BMI）及有无中心性肥胖、高血脂、糖尿病并发症、糖尿病家族史的T2DM患者药物治疗方法差异均有统计学意义（均P<0.01）;江苏省T2DM患者血糖控制达标率为32.5%,单用口服药治疗者、单用胰岛素治疗者和口服药联合胰岛素治疗者血糖控制达标率分别为34.7%、25.3%和17.7%;在调整了性别、年龄、文化程度、婚姻状况、地区、居住地、吸烟、饮酒、糖尿病病程、BMI及有无中心性肥胖、高血压、高血脂、糖尿病并发症、糖尿病家族史等混杂因素后,多因素非条件logistic回归分析结果显示,单用胰岛素治疗者和口服药联合胰岛素治疗者血糖控制达标率分别为单用口服药治疗者的0.679倍（OR=0.679,95%CI=0.599~0.770）和0.465倍（OR=0.465,95%CI=0.388~0.558）。结论 江苏省T2DM患者的药物治疗率较高,但血糖控制达标率较低,单用口服药治疗者的血糖控制达标率较高。     

4P医学模式对中老年2型糖尿病患者的影响

目的探讨4P医学模式对中老年2型糖尿病患者的影响。方法随机抽取吉首市社区31例年龄≥50岁确诊为糖尿病≥1年的患者进行问卷调查,并一对一实施4P医学模式,比较干预前后患者相关行为及生化指标的变化。计量资料组内比较采用配对t检验;计数资料比较采用χ2检验,P0.05为差异有统计学意义。结果干预后患者在血糖良好的标准、低血糖的处理、按时检测血糖、餐后锻炼、锻炼前准备、合理安排饮食、对患糖尿病持良好心态方面的知晓率明显提高,差异均有统计学意义(均P0.05)。执行4P医学模式后患者FPG、BMI[(7.3±2.1)mmol/L、(26.8±4.8)kg/m2]均比干预前[(8.6±3.0)mmol/L、(28.2±5.2)kg/m2]有了明显改善,差异均有统计学意义(均P0.05)。结论 4P医学模式对中老年2型糖尿病患者有积极影响,应逐步完善4P医学模式,增加易行性,以控制糖尿病的患病率及并发症。