团体认知行为干预对2型糖尿病患者血糖和自我管理水平的影响研究

目的 探讨团体认知行为干预对2型糖尿病患者的自我管理行为及血糖的影响。方法 944例患者以社区为单位随机分配到研究组和对照组。对照组开展常规随访,研究组在常规随访的基础上开展团体认知行为干预。比较3个月后研究组和对照组自我管理能力、糖化血红蛋白的差异。用密西根糖尿病自我管理评定量表(DCP)评估干预前后糖尿病患者的自我管理水平。干预前后2组自身情况比较采用重复测量方差分析;干预后的组间比较采用混合效应线性模型。结果 干预后,研究组HbAlc值较干预前下降,差异有统计学意义(7.97±1.92)% vs (7.25±1.39)%;F=45.673,P＜0.001],而对照组干预前后HbAlc值差异无统计学意义(7.92±1.77)% vs (7.68±1.93) % ;F=3.691,P=0.055]。干预前后2组自身比较,研究组除患者自我管理的坚持性因子得分差异无统计学意义之外(P=0.618),其他9个自我管理水平因子均较干预前有所提高(P值均＜0.05),对照组患者仅药物治疗问题、运动锻炼、病情控制、糖尿病知识理解自评和对疾病的态度5个因子得分较干预前有所提高(P均＜0.001);干预后,研究组的自我管理能力、饮食的依从性、病情控制问题和糖尿病知识的掌握程度均优于对照组(P＜0.05)。结论 团体认知行为干预可以提高患者的自我管理能力,改善患者的血糖水平。

Effect of group cognitive behavioral interventions on blood glucose and self-management levels in patients with type 2 diabetes

Objective To investigate the effects of group cognitive behavioral interventions on self-management behavior and blood glucose in patients with type 2 diabetes. Methods A total of 944 patients were randomly assigned to a study group and a control group in the community. The control group carried out the routine follow-up, and the study group carried out group cognitive behavioral interventions on the basis of the routine follow-up. The differences in self-management ability and glycated hemoglobin (HbAlc) between the study group and the control group after 3 months were compared. The Michigan Diabetes Self-Management Rating Scale (DCP) was used to assess the level of self-management in people with diabetes before and after the intervention. Repeated measurement ANOVA was used to compare the two groups before and after the intervention. Mixed-effects linear models were used for post-intervention comparisons between the two groups. Results After the intervention, the HbAlc value in the study group decreased compared with that before the intervention, and the difference was statistically significant: (7.97±1.92)% vs (7.25±1.39)%. F=45.673, P<0.001), but there was no significant difference in HbAlc values before and after the intervention in the control group: (7.92±1.77)% vs (7.68±1.93) %. F=3.691, P=0.055). Compared with the two groups before and after the intervention, except for the non-significant difference in the scores of adherence factors of self-management in the study group (P=0.618), the other nine self-management level factors were improved compared with those before the intervention (P value<0.05). The scores of the five factors of drug treatment, exercise, disease control, diabetes knowledge understanding, and attitude towards disease were improved in the control group compared with those before the intervention (P value<0.001). After the intervention, the self-management ability, dietary compliance, disease control problems, and diabetes knowledge of the study group were better than those of the control group (P<0.05). Conclusion Group cognitive behavioral intervention can improve patients’ self-management ability and improve their blood glucose levels.