临床治疗联合多重干预对社区2型糖尿病综合管理效果研究

The multiple intervention study on type 2 diabetes in community comprehensive management based on clinical treatment

目的评价临床治疗联合同伴支持、移动医疗技术和舒缓音乐治疗对社区糖尿病患者优化管理的必要性和可行性。 方法2014年1月，社区公共卫生医师通过电话招募上海市黄浦区瑞金二路街道社区卫生服务中心2型糖尿病患者，共372例患者自愿参加项目。根据入选排除标准，共剔除179例不符合标准的患者，最终入选193例研究对象。采用随机数字表法随机分成干预组（96例）和对照组（97例），对照组接受为期6个月的常规治疗和大组健康教育，干预组接受为期6个月的常规治疗和同伴小组组长组织的小组教育（第1阶段干预）；研究进行到第8个月，开展第2阶段研究，根据抑郁、睡眠障碍患者入选排除标准，入选45例。采用随机数字表法随机分成多重干预组（22例）和常规社区组（23例），开展6个月的多重干预研究。采用t检验比较两组患者干预后的糖化血红蛋白（HbA1c）、体质指数、腰臀比、自我效能得分以及匹兹堡睡眠评分（PSQI）、患者健康问卷（PHQ-9）得分情况。 结果第1阶段干预结束后，干预组的HbA1c与基线相比，前后差异无统计学意义（7.14%±1.17% vs.7.15%± 1.04%，t=0.148 ，P〉0.05），自我效能得分提高，差异有统计学意义（100.85±16.40 vs.109.20±13.88，t= 0.148，P〈0.05）；对照组的HbA1c，较基线升高，差异有统计学意义（7.26%±1.37% vs.7.53%±1.63%，t= 2.148，P〈0.05），自我效能得分升高，差异有统计学意义（97.36±14.34 vs.102.09±14.67，t=2.132，P〈0.05），且对照组与干预组在自我效能得分方面，差异有统计学意义（102.09±14.67 vs.109.20±13.88，t=2.643，P〈 0.05）。第2阶段干预结束后，与第8个月相比，多重干预组的PHQ-9得分（8.09±2.45 vs.2.55±1.67，t= 2.860，P〈0.05），自我效能总得分方面（104.09±16.40 vs.110.96±13.86 ，t=2.120 ，P〈0.05 ），差异有统计学意义（P〈0.05），且多重干预组PHQ-9得分（5.95±4.02 vs.2.55±1.67 ，t=2.630，P〈0.05），和自我效能得分均优于常规社区组差异有统计学意义（96.58±17.68 vs.110.96±13.86 ，t=2.962，P〈0.05）。结论在常规临床治疗基础上，联合多重干预，如同伴支持、移动医疗技术对社区2型糖尿病患者进一步改善临床治疗效果、自我管理行为以及疾病相关伴随状态等具有一定效果。

ObjectiveTo evaluate the necessity and practicability of optimizing the management of type 2 diabetes mellitus in community after acquiring the peer education and the music therapy to their physical and mental issues and sleep problems. MethodsTotally 179 type 2 diabetes mellitus patients who were followed up in Ruijin 2nd community health service center, the random numbers table used to randomize the patients into 2 groups：control group （97 cases） and experiment group （96 cases）, the conventional treatment was used in control group. Besides the conventional treatment measures, the peer support was used by patients in the experiment group. In the second step, 45 patients were met the inclusion and the exclusion criteria, the random numbers table used to randomize the patients into 2 groups：the multiple intervention group （22 cases） and the conventional treatment group （23 cases）, the multiple intervention included the music therapy, the peer support and the sleep health education, the conventional treatment included the conventional treatment and the sleep health education. The t test was used to compare the patient＇s HbA1c and other quantitative data in two groups of patients after the intervention. ResultsIn the first stage of research, compared with the control group patients, the patients ＇HbA1c in intervention group was significantly improvement after 6 months （7.26%±1.37% vs.7.53%±1.63%, t=2.148, P〈0.05）,besides, the intervention group individuals achieved significant improvement in diabetic self-management behaviors and self-efficacy after 6 months, and the improvement in self-efficacy of peer support group was significant different compared with routinely educated patients （104.09±16.40 vs.110.96± 13.86, t=2.120, P〈0.05）, and the PHQ-9 （5.95±4.02 vs.2.55±1.67, t=2.630, P〈0.05） between the two group had significant difference, while no improvement was found in PSQI, BMI, and WHR between intervention group and control group. ConclusionsPeer support could improve the blood glucose metabolism in patients with type 2 diabetes. With the effect of yoga music and physical exercises, peer support can improve the quality of sleep and decrease depression in T2DM patients, who also have sleep disorders and mild depression.