社区自我管理小组干预对2型糖尿病患者综合控制情况的长期和短期效果研究

Short-and Long-term Effects of Group-based Self-management Activities on Comprehensive Glycemic Control among Patients with Type 2 Diabetes in the Community

背景糖尿病自我管理是降低疾病影响及改善预后的重要手段。目前,糖尿病自我管理研究多以干预后短期效果评价为主,对长期效果的追踪报告较少。目的评价社区自我管理小组活动对2型糖尿病患者综合控制情况的长期和短期效果。方法于2014年3月,在北京市房山区招募500例成年2型糖尿病患者,随机分入对照组(n=241)和干预组(n=259)。两组患者均接受常规糖尿病随访服务,干预组患者在此基础上开展为期3个月的糖尿病自我管理小组活动。在干预前、3个月干预结束时、干预结束后2年和5年分别进行调查,收集两组患者的人口学信息、疾病信息、糖尿病综合控制指标[体质指数(BMI)、血压、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]。采用广义估计方程分析自我管理小组活动主效应,以及自我管理小组活动与干预后时间的交互效应。结果调整协变量后,自我管理小组活动在BMI、收缩压、舒张压、FPG、HbA1c、HDL-C、TG、LDL-C上的主效应不显著(P>0.05)。时间在各项指标上的主效应显著(P<0.05),相较于基线,患者BMI、收缩压、舒张压、FPG、HbA1c、HDL-C、LDL-C升高,TG降低。自我管理小组活动与干预后时间对BMI[β(95%CI)=-0.33(-0.62,-0.05)]、FPG[β(95%CI)=-1.03(-1.71,-0.35)]、TG[β(95%CI)=-0.54(-0.93,-0.14)]的影响存在交互效应:干预前干预组BMI比对照组低0.31 kg/m2,干预3个月后比对照组低0.64 kg/m2;干预前干预组FPG比对照组高0.19 mmol/L,干预后2年比对照组低0.84 mmol/L;干预前干预组TG比对照组高0.03 mmol/L,干预后5年比对照组低0.51 mmol/L。结论自我管理小组活动对2型糖尿病患者BMI控制有短期效果,对FPG、TG控制可能有长期效果。

Background Diabetes self-management is an important measure to reduce the adverse impact of the disease and improve the outcome in patients with diabetes.Existing diabetes self-management studies mainly focus on the evaluation of short-term intervention effects,but rarely report the long-term effects.Objective To evaluate the short-and long-term effects of group-based self-management activities on comprehensive glycemic control in type 2 diabetes patients in the community.Methods In 2014,500 adults with type 2 diabetes were recruited from Fangshan District,Beijing,and randomly divided into a control group(n=241)and an intervention group(n=259).Both groups received routine diabetes follow-up services.The intervention group also received a three-month group-based self-management activities.We conducted four surveys at different times(at baseline,and three months,two years and five years post-intervention)to collect patient demographics,disease condition,comprehensive glycemic control indicators[body mass index(BMI),blood pressure,fasting plasma glucose(FGP),glycated hemoglobin(HbA1c),high-density lipoprotein cholesterol(HDL-C),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)].Generalized estimating equations were used to analyze the main effect of the self-management activities and the interaction effect of the activities with post-intervention time.Results After adjusting for potential confounders,the main effects of the self-management activities on BMI,systolic blood pressure,diastolic blood pressure,FPG,HbA1c,HDL-C,TG an LDL-C were not statistically significant(P>0.05).The main effects of time of intervention on various indicators were statistically significant(P<0.05).Specifically,the BMI,systolic blood pressure,diastolic blood pressure,FPG,HbA1c,HDL-C and LDL-C increased,and TG decreased in the patients after intervention.We found the self-management activities and the intervention time had an interaction effect on BMI[β(95%CI)=-0.33(-0.62,-0.05)],FPG[β(95%CI)=-1.03(-1.71,-0.35)],and TG[β(95%CI)=-0.54(-0.93,-0.14)]:the BMI of the intervention group was 0.31 kg/m~2 lower than that of the control group at baseline,and was 0.64 kg/m~2 lower than that of the control group at three months post-intervention;the FPG of the intervention group was 0.19 mmol/L higher than that of the control group at baseline,but was 0.84 mmol/L lower than that of the control group at two years post-intervention;the TG of the intervention group was 0.03 mmol/L higher than that of the control group at baseline,but was 0.51 mmol/L lower than that of the control group at five years post-intervention.Conclusion Group-based self-management activities have a short-term effect on controlling BMI,and may have a long-term effect on controlling FPG and TG in patients with type 2 diabetes.