基于行为改变技术的远程糖尿病运动支持对2型糖尿病患者运动自我效能的影响

Effect of behavior change techniques based remote diabetes exercise support on exercise self-efficacy in patients with type 2 diabetes mellitus

目的探讨糖尿病共同照护模式下基于行为改变技术的远程糖尿病运动康复支持对2型糖尿病患者运动自我效能及糖化血红蛋白水平(HbA1c)的影响.方法纳入2018年1至12月在北京大学第一医院糖尿病共同照护门诊规律随访的持续6个月以上的2型糖尿病患者381例,其中自愿接受3个月远程运动干预者纳入运动干预组[45例,年龄(50.4±12.8)岁,女性24例(53.3%),病程4.6(0.8,12.0)年],其余为非运动干预组[336例,年龄(57.8±11.6)岁,女性155例(46.1%),病程10.3(2.8,16.0)年].运动干预组接受线下运动指导师评估后,根据基线运动自我效能量表评分,高自我效能亚组仅接受运动提醒及电子运动处方推送;低自我效能亚组患者接受基于行为改变技术的依据个体化运动处方生成的运动视频指导.以年龄、病程、性别、体质指数、基线HbA1c水平为协变量,采用倾向性评分匹配法分析运动干预及非运动干预组中基线HbA1c不达标的患者半年后HbA1c的差异.采用t检验及Wilcoxon检验进行数据分析.结果与基线时相比,低自我效能组半年后运动自我效能[40(31,54)比55(26,83)分,Z=-2.229,P=0.026]及运动自我管理能力得分[2(2,4)比4(3,5)分,Z=-2.401,P=0.016]均显著提高.倾向性评分匹配后,相比于基线时,半年后运动干预组患者HbA1c水平显著降低(8.9%±2.0%比6.9%±0.8%,t=5.723,P<0.00001).结论在有效的糖尿病多学科综合管理背景下,实施基于行为改变技术的远程运动支持,能够提高2型糖尿病患者运动自我效能,并改善血糖控制不佳患者HbA1c水平.

Objective To investigate the effects of remote exercise rehabilitation support based on behavior change techniques on exercise self-efficacy and glycosylated hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 381 patients with T2DM who were followed up for more than 6 months in Peking University First Hospital Diabetes Shared Care Clinic from January to December 2018 were enrolled. The patients who voluntarily received a 3-month behavior change techniques based remote exercise intervention were assigned to exercise intervention group [45 cases,(50.4±12.8) year-old, female 24 cases (53.3%), diabetes duration was 4.6 (0.8, 12.0) year] and the rest were in non-exercise intervention group [336 cases,(57.8±11.6) year-old, female 155 cases (46.1%), diabetes duration was 10.3 (2.8, 16.0) year]. After evaluated by exercise coach, patients in exercise intervention group with higher baseline self-efficacy scale scores only received exercise reminders and electronic exercise prescription, and those with lower self-efficacy received individualized video exercise prescription based on behavior change techniques. Including age, disease duration, gender, body mass index, and baseline HbA1c were used as covariates, the propensity score analysis was used to compare the change of HbA1c at six months for patients with uncontrolled baseline HbA1c between exercise intervention group and non-exercise intervention group. The t test and Wilcoxoh test were used for data analysis. Results Compared with baseline, both exercise self-efficacy score [40 (31, 54) vs 55 (26, 83) points, Z=-2.229, P=0.026] and exercise self-management ability score [2 (2, 4) vs 4 (3, 5) points, Z=-2.401, P=0.016] were significantly improved after six month in low exercise self-efficacy group. HbA1c were significantly lower in the exercise intervention group compared with baseline (8.9%±2.0% vs 6.9%±0.8%, t=5.723, P<0.000 01). Conclusion In the context of effective multidisciplinary management of diabetes, implementation of behavioral change technique-based remote exercise support can improve exercise self-efficacy and HbA1c in patients with poor controlled T2DM.