团体认知行为治疗在门诊2型糖尿病患者中的应用探索

Effects of group cognitive behavior therapy in patients with type 2 diabetes mellitus

目的探讨团体认知行为治疗对2型糖尿病(T2DM)患者心理状况及血糖控制的影响。方法将在内分泌科门诊招募的2型糖尿病患者随机分为试验组(20例)与对照组(20例)。对照组为降糖药物治疗及健康教育,试验组在常规治疗的基础上合并团体认知行为治疗。于干预前后评估焦虑自评量表(SAS)、社会支持量表(SSRS)、世界卫生组织生存质量测定量表简表中文版(WHOQOL-BREF中文版)和空腹血糖(FG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)等指标。结果干预后试验组SAS较干预前降低(P <0. 05),SSRS总分及客观支持分较干预前升高(P <0. 05),干预后试验组WHOQOL-BREF生理领域、心理领域、社会关系领域及环境领域评分较干预前升高(P <0. 05)。干预后两组2hPG、HbA1c值均较各自干预前下降(P <0. 05),两组干预前后2hPG、HbA1c变化的差值比较差异均无统计学意义(P> 0. 05)。结论团体认知行为治疗可降低门诊2型糖尿病患者的焦虑水平、改善社会支持、提高患者的生存质量。团体认知行为治疗联合常规治疗可有效降低T2DM患者的餐后2 h血糖、糖化血红蛋白。

Objective To explore the effects of group cognitive behavior therapy on psychological condition and glucose control in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 40 patients with T2DM recruited in endocrinologydepartment were randomized into experimental group （n = 20） and control group （n = 20）. Both groups were given glucoselowering drugs and health education, while the experimental group was intervened by group cognitive behavior therapy added. All patients were assessed with Self Anxiety Scale（SAS）, Social Support Rating Scale （SSRS）, WHO Quality of Life Scale Brief Version （WHOQOL-BREF） and fasting blood-glucose （FG）, 2h postprandial blood-glucose （2hPG）, glycosylated hemoglobin （HbAlc） before and after intervention. Results After intervention, the total score of SAS decreased significantly in experimental group （ P 〈 0. 05 ） ; the total score and factor score of objective support of SSRS increased significantly in experimental group（ P 〈 0.05 ） and factor scores of physiology, psychology, social relation and environment of WHOQOL-BREF in experimental group increased significantly （P 〈 0. 05 ）. After intervention, the levels of 2hPG and HbA1 c in both groups decreased significantly （ P 〈 0. 05 ） ; There existed no differences in the reduction of 2hPG and HbA1 c before and after intervention between two groups （ P 〉 0.05 ）. Conclusion Group cognitive behavior therapy may improve anxiety level, social support and quality of life in patients with T2DM. Also group cognitive behavior therapy combined with conventional therapy may effectively reduce the levels of 2hPG and HbAlc of patients with T2DM.