短期持续皮下胰岛素输注后初发2型糖尿病患者自我管理行为的调查

目的探讨短期持续皮下胰岛素输注(continuous subcutaneous insulin infusion,CSII)后初发2型糖尿病患者自我管理行为的情况。方法对经CSII治疗后的118例初发2型糖尿病患者进行自我管理教育,分别在出院时,出院后3、6、12个月观察和了解其血糖水平控制情况,并根据血糖水平控制情况分为缓解组和治疗失效组。比较两组患者自我管理行为和生化指标变化情况。结果 65例(缓解组)患者可较好地控制血糖水平,53例(治疗失效组)患者不能较好地控制血糖水平。CSII治疗后缓解组患者的空腹血糖(FPG)和餐后2h血糖(2hBG)低于治疗失效组(均P<0.05);两组在出院时和出院后各时间段饮食执行情况比较,差异具有统计学意义(均P<0.05);运动锻炼和自我血糖监测执行情况,两组在出院时和出院后3个月比较,差异无统计学意义(均P>0.05),而两组在出院后6、12个月比较,差异具有统计学意义(均P<0.05)。结论 CSII治疗后获得临床症状缓解的初发2型糖尿病患者,其血糖控制水平与自我管理行为存在着一定的关系,良好的自我管理水平可较好地控制血糖,进而使其获得更长的临床缓解期。     

胰岛素泵强化治疗继发性磺酰脲类药物失效的临床研究

目的采用胰岛素泵强化治疗2型糖尿病（T2DM）继发性磺酰脲类药物（SU）失效以评介其临床疗效。方法将45例继发性SU失效患者随机分为胰岛素泵持续皮下输注（CSII）组23例和多次皮下注射胰岛素（MDI）组22例，均连续2周，比较两组治疗前后的空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、血糖达标时间、平均每日胰岛素（Ins）用量及低血糖反应。结果两组治疗后均能显著降低患者的FIG、2hPG、HbA1c（P均〈0．01），但CSII组较MDI组降低更为明显（P〈0．01），CSII组血糖达标时间短（P〈0．01），平均每日Ins用量少（P〈0．05），低血糖反应少（P〈0．05）。结论胰岛素泵能更有效迅速地控制血糖，节省Ins用量，延缓胰岛B细胞功能衰竭，且低血糖反应少。     

胰岛素泵治疗初诊2型糖尿病疗效观察

目的观察持续皮下胰岛素泵注射（CSII）在初诊2型糖尿病患者治疗中的有效性和安全性。方法初诊2型糖尿病患者76例,随机分为持续皮下胰岛素泵注射组（CSII组,40例）和多次皮下注射胰岛素组（MSII组,36例）进行胰岛素强化治疗,分别监测治疗前后的空腹血糖（FPG）、餐后2 h血糖（2 h PG）、每日胰岛素用量、血糖达标所需时间、低血糖事件发生率。结果两组均能有效的控制血糖,但是CSII组与MSII组相比血糖达标所需时间更短,胰岛素用量更少,且低血糖事件的发生率显著减少。结论胰岛素泵（CSII）治疗初诊2型糖尿病是一种有效且安全性高的临床治疗方法。     

对老年糖尿病患者进行自我管理的临床效果评价

目的：探讨对老年糖尿病患者实施自我管理教育的临床效果。方法选择2011年6月-2012年12月收治的老年糖尿病患者80例,随机分实验组42例和对照组38例。对照组按常规方法指导;实验组对患者进行自我管理教育,内容包括糖尿病饮食、运动、药物治疗、病情监测、自我监测、临床表现、并发症等。比较2组患者出院6个月后空腹血糖、早餐后2h血糖、糖化血红蛋白（ HbA1C）、体重指数。结果实验组出院6个月后的空腹血糖、早餐后2h血糖、糖化血红蛋白（HbA1C）和体重指数指标均优于对照组（P〈0.05）。结论自我管理教育能提高老年糖尿病患者治疗依从性,提高血糖控制疗效,有助于提高老年糖尿病患者生活质量。     

行为分阶段转变理论在老年2型糖尿病病人血糖控制中的应用

[目的]探讨行为分阶段转变理论对老年2型糖尿病病人血糖控制及自我管理能力的影响。[方法]将我院收治的244例老年2型糖尿病病人随机分为观察组与对照组,每组122例,对照组采用常规治疗及传统健康教育,观察组在常规治疗的基础上对病人进行基于行为分阶段转变理论的健康教育,干预时间6个月。比较两组病人干预前后空腹血糖（FBG）、餐后2 h 血糖（2 hPBG）、糖化血红蛋白（HbA1 c）、自我管理行为的情况。[结果]干预后两组病人血糖控制情况及自我管理行为明显优于干预前（P〈0.05）;干预后观察组 FBG、2hPBG、HbA1 c、自我管理行为各维度得分均明显优于对照组（P〈0.05）。[结论]基于行为分阶段转变理论的健康教育能有效帮助老年2型糖尿病病人控制血糖,提高自我管理行为能力。     

短期应用胰岛素泵强化治疗初发2型糖尿病疗效观察

【目的】观察短期应用胰岛素泵输注胰岛素（CSII）治疗的初发2型糖尿病患者2年的胰岛β细胞功能的变化,分析影响长期缓解率的相关因素。【方法】56例空腹血糖〉11.1mmol/L的初发2型糖尿病患者进行2周的CSII强化治疗并随访2年,对治疗前、后不同时期的FBG,2 hBG,HbA1c,胰岛β细胞功能Homa-β及胰岛素抵抗指数Homa-IR的变化进行评估。【结果】①CSII强化治疗2周后,56例患者的FBG、2 hBG、HbA1c水平较治疗前显著下降（P〈0.001）;Homa-IR较治疗前下降（P〈0.05）,Homa-β较治疗前增高（P〈0.01）。②随访至24个月时仍有18例（32.14%）维持单纯饮食和运动治疗达良好血糖控制,其Homa-IR及Homa-β与停泵时比较无变化;另有38例（67.86%）血糖控制不佳,继续胰岛素和（或）口服药治疗,此组患者在入选时HbA1c水平、治疗后血糖达标天数及达标时胰岛素用量均较高（P〈0.05）。【结论】对伴有明显高血糖的初发2型糖尿病患者,短期应用胰岛素泵持续皮下输注胰岛素能改善和（或）恢复胰岛β细胞功能,重建饮食和运动治疗对血糖的反应性。     

胰岛素泵短期强化治疗磺脲类继发失效的临床观察

目的：观察胰岛素泵（胰岛素皮下连续脉冲式输注，CSII）对磺脲类药物继发性失效的2型糖尿病患者强化治疗的效果。方法：将38例磺脲类药物继发性失效的2型糖尿病患者分为两组，分别予胰岛素泵2、4周强化治疗。结果：经胰岛素泵强化治疗后，所有患者的空腹血糖、餐后2h血糖、糖化血红蛋白都有明显下降（P〈0．01），餐后2hC肽明显升高（P〈0．01）；结论：对于磺脲类药物继发性失效的2型糖尿病患者，CSII强化治疗为一有效的治疗方式     

配对血糖监测方案干预对糖尿病患者疾病自我管理能力的效果评价

目的探讨配对血糖监测方案对糖尿病患者疾病自我管理能力及血糖控制水平的影响。 方法以2017年1月至2018年6月在北京大学第一医院糖尿病共同照护门诊规律就诊（频率为每3个月一次复诊）一年以上的患者为研究对象,进行干预前后分析。分别在患者初诊及随访1年后测定糖化血红蛋白（HbA1c）、身高、体质量,计算体质量指数（BMI）,并使用《糖尿病自我管理行为量表6》评价其自我管理能力。于患者初诊时指导患者居家进行餐前餐后配对血糖监测,并依据监测结果适当调整饮食、运动等活动。于1年诊时,调查患者就诊前1个月平均每周实际配对血糖监测频次。采用Wilcoxon检验比较不同配对监测频次患者在自我管理能力评分各方面（饮食、运动、自我血糖监测、遵医嘱血糖监测、足部护理和用药）的差异。采用t检验比较不同配对监测频次组间BMI及HbA1c的差异。 结果符合入选标准并完成数据收集及量表评估的患者共153例。1年诊就诊前1个月内,平均每周配对血糖监测<1次的患者86例为非配对监测组,配对血糖监测≥1次的患者67例为配对监测组。1年诊时,配对监测组与非配对监测组在饮食［7.00（5.00~7.00）分vs 5.00（3.00~7.00）分］、自我监测血糖［4.50（2.00~7.00）分vs 2.00（0.25~4.00）分］及遵医嘱血糖监测［5.00（2.00~7.00）分vs 2.00（0~3.75）分］方面比较得分均较高,差异均具有统计学意义（Z=-2.663,P=0.008;Z=-3.851,P<0.001;Z=-3.892,P<0.001）;在运动、足部护理及用药方面得分比较,差异均无统计学意义（P均>0.05）。在初诊和1年诊时,非配对监测组和配对监测组BMI和HbA1c方面比较,差异均无统计学意义（P均>0.05）。 结论配对血糖监测方案有助于糖尿病患者依据血糖结果调整饮食,促进健康饮食行为,并提高其血糖监测依从性。     

动态血糖监测系统和胰岛素泵在脆性糖尿病患者围术期中的应用

目的：探讨动态血糖监测系统和胰岛素泵在围术期中控制脆性糖尿病患者血糖的效果。方法：将60例围术期脆性糖尿病患者随机分为3组：组1术前采用动态血糖监测系统与胰岛素泵治疗模式（CGMS＋CSII组）,组2术前采用单纯胰岛素泵治疗（CSII组）,组3术前采用胰岛素多次注射治疗（MDI组）,后两组采用指端血糖监测;比较3组治疗3d后的血糖控制情况、血糖达标率、平均血糖（MBG）、平均血糖波动幅度（MAGE）及低血糖次数。结果：治疗3d后CGMS＋CSII和CSII两组患者的空腹血糖、3餐后血糖、晚23：00血糖及凌晨3：00血糖均明显低于治疗前（P〈0.05）,血糖达标率分别为75.0%和60.0%,MDI组患者的空腹血糖及全日血糖稍低于治疗前,无显著性差异（P〉0.05）,血糖达标率仅为10.0%;胰岛素泵治疗3d后患者的MBG和MAGE较治疗前均明显下降（P〈0.05）,其中CGMS＋CSII组患者的MBG、MAGE均显著低于CSII组（P〈0.05）,MDI组MBG、MAGE较治疗前无明显下降（P〉0.05）;胰岛素治疗前CGMS＋CSII组患者1d发现低血糖次数多于CSII组和MDI组（P〈0.05）;治疗3d后CGMS组患者的低血糖次数低于治疗前（P〈0.05）,而CSII组和MDI组患者的低血糖次数高于治疗前（P〈0.05）。结论：胰岛素泵强化治疗可以快速稳定控制血糖,动态血糖检测系统能全面提供血糖水平的信息,及时发现和减少血糖波动及低血糖反应,与胰岛素泵在临床上联合应用更有利于脆性糖尿病患者围术期中的血糖控制达标。     

生命力护理干预对2型糖尿病患者自我管理能力的影响

目的：探讨生命力护理干预对2型糖尿病患者自我管理能力的影响。方法：将240例糖尿病患者随机分成试验组和对照组各120例,两组均给予常规护理治疗,即常规的糖尿病健康宣教,包括血糖自我监测、饮食指导、用药指导、运动方式及运动量、自我管理、复查时间等内容。试验组在此基础上实施系统的、连贯的生命力护理干预（营养、心理、运动、康复指导等）。比较两组患者自我管理能力及血糖控制情况。结果：干预半年后,试验组患者自我管理各项得分明显高于对照组（P〈0.05）,空腹血糖、餐后2 h血糖、糖化血红蛋白、甘油三酯低于对照组（P〈0.05）。结论：生命力护理干预能有效提高糖尿病患者自理能力,值得临床推广应用。     

Structured personal diabetes care in primary health care affects only women's HbA1c

OBJECTIVE: Diabetic men and women differ in lifestyle and attitudes toward diabetes and may benefit differently from interventions to improve glycemic control. We explored the relation between HbA1c (A1C), sex, treatment allocation, and their interactions with behavioral and attitudinal characteristics in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Six years after their diabetes diagnosis, a population-based sample of 874 primary care patients cluster-randomized to receive structured personal care or routine care reported lifestyle, medication, social support, diabetes-related consultations, and attitudes toward diabetes. Multivariate analyses were applied, split by sex. RESULTS: A marked intervention effect on A1C was confined to the structured personal care women. The median A1C was 8.4% in structured personal care women and 9.2% in routine care women (P < 0.0001) and 8.5% in structured personal care men and 8.9% in routine care men (P = 0.052). Routine care women had a 1.10 times higher A1C than structured personal care women, (P < 0.0001, adjusted analysis). Structured personal care women had relatively more consultations than routine care women, but neither number of consultations nor other covariates helped to explain the sex difference in A1C. Irrespective of treatment allocation, women had more adaptive attitudes toward diabetes but lacked support compared with men. CONCLUSIONS: In this study, the observed effect of structured personal care on A1C was present only among women, possibly because they were more inclined to comply with regular follow-up and had a tendency to have a more adaptive attitude toward diabetes.     

Pharmacists' attitudes toward diabetes and their involvement in diabetes education

OBJECTIVE: To determine the relationship between pharmacists' attitudes toward diabetes and their involvement in diabetes patient education in the community setting. METHODS: Registered pharmacists in Arizona were mailed surveys regarding their attitudes toward diabetes and their involvement in diabetes patient education. Attitudes were measured using the Diabetes Attitude Scale (DAS); the types of educational skills evaluated were based on those recommended by the American Diabetes Association's Standards of Medical Care. RESULTS: Pharmacists' attitudes were significantly positive toward the need for special training for diabetes care, the importance of tight glycemic control, the team approach to care, and the preference for diabetes education in an outpatient setting (p < 0.001). The majority of the time, pharmacists provided basic patient education (52%) rather than intermediate or advanced patient education (26% and 27%, respectively). There was a negative correlation between the attitude that diabetes is a difficult disease to treat and pharmacists' involvement in diabetes patient education (p < 0.05). This indicates that, although pharmacists believe that diabetes is a treatable disease, they infrequently provide diabetes patient education. CONCLUSIONS: Overall, pharmacists had positive attitudes toward diabetes. These attitudes did not correlate with the degree of their involvement in diabetes patent education. More diabetes patient education through community pharmacists is needed.     

The short-term impact of a continuing medical education program on providers' attitudes toward treating diabetes

OBJECTIVE: The objective of this study was to evaluate the short-term impact of a 7-h type 2 diabetes continuing medical education (CME) program. Outcomes included a measure of health care providers' diabetes knowledge and the Diabetes Attitude Scale (DAS), a validated measure of attitudes toward diabetes. RESEARCH DESIGN AND METHODS: A CME program on type 2 diabetes was presented by an expert panel in Chicago during November 1998. A before-after trial with pre- and postintervention measurements of diabetes knowledge and attitudes toward diabetes was administered as part of the program. A convenience sample of the 129 health care providers in attendance resulted in 91 (71%) completed pre- and postintervention surveys. RESULTS: Within-subjects analysis revealed increases in knowledge and more favorable attitudes toward diabetes after the program. Between-subjects analysis revealed that attitude changes differed for physicians as compared with allied health care providers. CONCLUSIONS: A CME program was associated with an increase in knowledge of diabetes and more favorable attitudes toward diabetes as measured by the DAS. The DAS changes were subtly different for the physician group as compared with the allied health care provider group. These results suggest that the DAS can be a useful instrument for measuring the short-term impact of educational interventions.     

2型糖尿病患者围手术期使用胰岛素泵治疗的管理

目的探讨对2型糖尿病患者围手术期使用胰岛素泵治疗的管理方法和体会。方法对我院50例围手术期采用胰岛素泵治疗的2型糖尿病患者,从糖尿病治疗的5个方面对胰岛素泵治疗进行管理。结果系统治疗和管理后,患者血糖得到有效控制,空腹、餐后2 h血糖均低于治疗前(P<0.01或P<0.05),对糖尿病的相关知识掌握优良率高于治疗前(P<0.05)。结论胰岛素泵逐步用于围手术期2型糖尿病患者,对其进行系统治疗和管理非常必要。     

Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally effective in type 2 diabetes: a randomized,parallel-group, 24-week study

OBJECTIVE: Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA(1c) and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings. RESULTS: HbA(1c) values decreased similarly for both groups from baseline (8.2 +/- 1.37% for CSII, 8.0 +/- 1.08% for MDI) to end of study (7.6 +/- 1.22% for CSII, 7.5 +/- 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 +/- 48 vs. 192 +/- 65 mg/dl for CSII and MDI, respectively; P = 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups. CONCLUSIONS: Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes. Patients with type 2 diabetes can be trained as outpatients to use CSII and prefer CSII to injections, indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes.     

妊娠期糖尿病患者功能失调性态度对孤独感的影响

目的:探讨妊娠期糖尿病患者功能失调性态度对孤独感的影响,为妇产科护士对患者进行针对性的健康教育提供参考意见。方法:对239例妊娠期糖尿病患者运用"中文版功能失调性态度问卷"和"感情与社会孤独量表"进行测试。结果:功能失调性态度和孤独感的分数分别为(3.24±0.79)分和(3.28±0.41)分;功能失调性态度和孤独感均处于中等水平,功能失调性态度与孤独感呈显著性相关关系;功能失调性态度3个维度能联合预测孤独感28.8%的变异量。结论:功能失调性态度能有效地预测妊娠期糖尿病患者的孤独感,妇产科护士应针对患者功能失调性态度进行相应的健康教育以减轻其孤独感。     

The influence of treatment modality and ethnicity on attitudes in type 2 diabetes

OBJECTIVE: The study examines diabetes attitude differences by treatment modality (insulin vs. no insulin), race/ethnicity, and the interaction of these two variables for people with type 2 diabetes. RESEARCH DESIGN AND METHODS: Data were collected with the Diabetes Care Profile (DCP), an instrument that assesses psychosocial factors related to diabetes. Participants (n = 672) were recruited in the metropolitan Detroit, Michigan, area from 1993 to 1996. A total of 68% of these participants were African-Americans with type 2 diabetes, and 32% were Caucasians with type 2 diabetes. Analyses of covariance were performed to examine the effects of race/ethnicity, treatment, and their interaction for each DCP scale. RESULTS: The four patient categories (two ethnicities by two treatment modalities) differed by age, years with diabetes, education, and sex distribution. Treatment modality had a significant effect on 6 of the 16 DCP scales (Control, Social and Personal Factors, Positive Attitude, Negative Attitude, Self-Care Ability, and Exercise Barriers). Ethnicity was a significant effect for three scales (Control, Support, and Support Attitudes). The interaction of race/ethnicity and treatment modality was a significant effect for two related attitude scales (Positive Attitude and Negative Attitude). CONCLUSIONS: The results suggest that attitudes toward diabetes are similar for African-American and Caucasian patients with type 2 diabetes. The results also suggest that treatment modality has a greater effect on attitudes than either race/ethnicity or the interaction effect. However, Caucasian patients using insulin differed from the other patient groups by having the least positive and the most negative attitudes regarding diabetes.     

Learning to empower patients. Results of professional education program for diabetes educators

The patient empowerment approach to diabetes education is intended to enable patients to make informed decisions about their own diabetes care and to be fully responsible members of the health-care team. Facilitating patient empowerment requires a specific set of skills and attitudes on the part of diabetes educators. A professional education program designed to facilitate the acquisition and enhancement of the requisite skills and attitudes was designed, implemented, and evaluated. The program involved adhering to a simulated diabetes care regimen for 3 days followed by a 3-day intensive skills-based workshop. The 23 educators who participated in the first two offerings of this program made significant gains in their counseling skills and demonstrated a positive change in attitude.     

A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes

OBJECTIVE: This study assesses the effects of insulin pump therapy on diabetes control and family life in children 1-6 years old with type 1 diabetes. RESEARCH DESIGN AND METHODS: Twenty-six children with type 1 diabetes for >/=6 months were randomly assigned to current therapy (two or three shots per day using NPH insulin and rapid-acting analog) or continuous subcutaneous insulin infusion (CSII) for 6 months. After 6 months, current therapy subjects were offered CSII. Changes in HbA(1c), mean blood glucose (MBG), hypoglycemia frequency, diabetes-related quality of life (QOL), and parental adjustment were recorded. RESULTS: Eleven subjects from each group completed the trial (age 46.3 +/- 3.2 months [means +/- SE]). At baseline, there were no differences between groups in HbA(1c), MBG, age, sex, diabetes duration, or parental QOL. Mean HbA(1c), MBG, and parental QOL were similar between groups at 6 months. Mean HbA(1c) and MBG did not change from baseline to 6 months in either group. The frequency of severe hypoglycemia, ketoacidosis, or hospitalization was similar between groups at any time period. Subjects on CSII had more fasting and predinner mild/moderate hypoglycemia at 1 and 6 months. Diabetes-related QOL improved in CSII fathers from baseline to 6 months. Psychological distress increased in current therapy mothers from baseline to 6 months. All subjects continued CSII after study completion. CONCLUSIONS: CSII is safe and well tolerated in young children with diabetes and may have positive effects on QOL. CSII did not improve diabetes control when compared with injections, despite more mild/moderate hypoglycemia. The benefits and realistic expectations of CSII should be thoroughly examined before starting this therapy in very young children.     

持续皮下胰岛素输注与多次皮下胰岛素注射在2型糖尿病围手术期血糖控制疗效观察

目的 比较2型糖尿病围手术期应用持续皮下胰岛素输注(CSII)和多次皮下胰岛素注射(MSII)的血糖控制效果.方法 将外科疾病合并2型糖尿病患者180例随机分为2组,98例为CSII组(持续皮下胰岛素输注诺和灵R),82例为MSII组(多次皮下注射诺和灵R和诺和灵N,所用剂量根据患者不同情况而定),观察2组患者治疗前后不同时点的血糖变化、血糖达标时间、平均胰岛素用量、低血糖发生率、术后切口感染率及住院天数的变化.结果 CSII组治疗后各时点血糖控制及其其他相关指标均优于MSII组,即CSII组治疗后空腹血糖[(4.8±1.6)mmol/L]控制效果优于MSII组[(6.4±2.1)mmol/L](t=7.74,P<0.05);早餐后2 h血糖控制效果[(7.6±2.3)mmol/L]优于MSII组[(9.3±2.4)mmol/L](t=7.72,P<0.05);血糖迭标时间[(4.1±2.9)d]明显短于MSII组[(6.9±2.0)d](t=2.81,P<0.05);平均胰岛素用量[(40.7±10.3)U]明显少于MSII组[(63.2±17.0)U](t=3.57,P<0.05);低血糖发生率(9.20%)较MSII组(3.05%)低(χ~2=4.92,P<0.05);CSII组切口感染率(0.0%)较MSII组(10.9%)低(χ~2=4.18,P<0.05);住院天数[(15.3±7.2)d]明显短于MSII组[(22.5±9.7)d](t=3.12,P<0.05).结论 2型糖尿病患者在围手术期应用持续皮下胰岛素输注控制血糖迅速、有效、安全.