多元系统化心理干预对社区老年2型糖尿病伴焦虑患者血糖控制及生活质量的影响

Effects of multiple systematic psychological intervention on blood glucose control and quality of life of elderly patients with T2DM and anxiety in community

目的探讨多元系统化心理干预对于老年2型糖尿病(T2DM)伴焦虑患者血糖控制及生活质量的影响。方法将2021年9月—2022年6月在上海市长宁区新华街道社区卫生服务中心签约慢病管理对象中已确诊为糖尿病的老年患者,运用焦虑自评量表(SSA)筛选符合要求的社区T2DM伴有焦虑的老年患者,简单随机抽样法抽取96例,应用随机数字表法分为干预组和对照组,每组48例。对照组每月面对面常规诊疗1次,未能按时来就诊的患者,则由家庭医生电话追访。干预组在常规诊疗基础上,增加多元系统化心理干预方案,包括每2周进行1次支持性心理治疗和家庭治疗指导,每月进行1次个体干预。比较2组3个月和6个月时糖化血红蛋白(HbA1c)、焦虑自评量表(SAS)评分及糖尿病生存质量特异性量表(DSQL)评分变化情况,分析多元系统化心理干预对患者心理和血糖控制的影响。结果经过多元系统化心理干预后:(1)与对照组相比,干预组6个月时的HbA1c水平有所下降(MD=-0.7,95%CI:-1.212-0.188,P=0.007),差异有统计学意义。(2)干预组基线SAS评分高于对照组,但在3个月和6月时的SAS评分分别较对照组降低(MD=-10.08,95%CI:-11.05-9.12,P<0.001)、(MD=-16.37,95%CI:-17.53-15.22,P<0.001),差异有统计学意义。(3)6个月时,干预组DSQL总分也较对照组有所减少(MD=-16.27,95%CI:-21.89-10.65,P<0.001),差异有统计学意义。结论多元系统化心理干预有利于老年2型糖尿病(T2DM)伴焦虑患者的血糖控制。

Objective To investigate the effects of multiple systematic psychological intervention on blood glucose control and quality of life of elderly patients with type 2 diabetes mellitus(T2DM)and anxiety.Methods Among chronic disease management subjects contracted with Community Health Service Center of Xinhua Street,Changning District from September 2021 to June 2022,elderly patients diagnosed with T2DM were selected.Self-Rating Anxiety Scale(SSA)was used to screen eligible elderly patients with T2DM and anxiety in the community.96 cases were selected by simple random sampling method and divided into intervention group and control group by random number table method,with 48 cases in each group.The control group receives routine face-to-face diagnosis and treatment once a month,and the patients who failed to see a doctor on time would be followed up by their family doctor by phone.On the basis of routine diagnosis and treatment,the intervention group added a multiple systematic psychological intervention plan,including supportive psychotherapy and family therapy guidance once every two weeks,and individual intervention once a month.The changes of HbA1c,SAS score and Diabetes Quality of Life Specific Scale(DSQL)score were compared between the two groups at 3 and 6 months.The effects of multiple systematic psychological intervention on patients psychology and blood glucose control were analyzed.Results After multiple systematic psychological interventions:(1)Compared with the control group,the HbA1c level of the intervention group decreased at 6 months(MD=-0.7,95%CI:-1.212 to-0.188,P=0.007),the difference was statistically significant.(2)The baseline SAS score of the intervention group was higher than that of the control group,but the SAS scores at 3 and 6 months were significantly lower than those of the control group[(MD=-10.08,95%CI:-11.05---9.12,P<0.001)and(MD=-16.37,95%CI:-17.53---15.22,P<0.001)],respectively,the differences were statistically significant.(3)At 6 months,the total DSQL score of the intervention group was significantly lower than that of the control group(MD=-16.27,95%CI:-21.89---10.65,P<0.001),and the difference was statistically significant.Conclusion Multiple psychological intervention is beneficial to blood glucose control in elderly patients with T2DM and anxiety.