衛教合併行為修正策略對糖尿病人代謝控制的影響

Impacts of Health Education with Behavioral Modification Strategies on Metabolic Control for the Diabetics

糖尿病人本身是攸關醫療照護成效最重要的人。許多臨床研究發現多數的非胰島素依賴型糖尿病人血糖控制不良的原因，乃是病患缺乏藥物知識，以及執行飲食限制、規律運動不夠積極。本研究之目的在評估飲食運動衛教合併行為修正策略，對非胰島素依賴型糖尿病患者代謝控制的影響。研究採實驗設計，在某醫學中心新陳代謝科門診進行。選取罹病半年至五年內且識字的，30～70歲，非胰島素依整型糖尿病人60人。再隨機分派病人至實驗組及對照組各30名。實驗組病患在2個月內接受研究者所提供之飲食運動衛教合併行為修正策略。對照組病人只給門診的護理常規。兩組病人分別用研究者擬定之三份問卷評估其關於糖尿病飲食運動之認知、態度和行為的得分，並且檢驗代謝控制指標包括血糖控制、血脂肪和體重。研究結果發現，衛教實施兩個月後：(1)實驗組病人於衛教後的關於糖尿病飲食運動之認知、態度和行為的得分較衛教前有顯著進步。(2)實驗組病人於衛教後的飯後血糖值與糖化血色素值較衛教前有顯著進步。(3)實驗組病人於衛教後的總膽固醇、高密度脂蛋白值、log（總膽固醇／高密度脂蛋白）值、log（低密度脂蛋白／高密度脂蛋白）值、和三酸甘油脂值皆有顯著改善。(4)實驗組病人於衛教後的體重顯著下降。飲食運動衛教合併行為修正策略對非胰島素依賴型糖尿病患者的代謝控制確有正向的影響。

The patient is the most important person in the health care of diabets. Several studies have reported that ,in most cases, failure to improve glycemic control in diabetics results from the patient's poor knowledge of drugs,and from failure to comply with a restricted diet and exercise regularly. This study was designed to ascertain the impact of diet and exercise health education combined with a behavioral modification strategies program on metabolic control for patients with non-insulin-dependent diabetes mellitus(NIDDM). A prospective, randomized, controlled clinical trial among persons who had NIDDM for longer than 6 months and less than 5 years was conducted in out-patient clinics of the metabolic department of a medical center. Sixty literate men and women aged 30 to 70 years completed the 2-month program. Subjects were randomly assigned to the experimental group (n=30) or control group (n=30). Diet and exercise health education along with the behavioral modification strategies program was given in the experimental group but not in the control group. Three investigator-derived questionnaires were used to evaluate the patients scores of knowledge acquisition, attitude change, and behavior performance regarding diet and exercise. Blood glucose control, serum lipid levels, and body weight were measured before and after the intervention to assess the metabolic control. The experimental group demonstrated 1) improved scores in knowledge, attitude, and behavior regarding diet and exercise; 2) improvements in blood glucose control as indicated by fasting plasma glucose, 2 hours after meal plasma glucose, and glycosylated hemoglobin (HbA1c) levels; 3) improvements in serum lipid levels as indicated by cholesterol, high-density lipoprotein, log (cholesterol/high-density lipoprotein), log (low-density lipoprotein/high-density lipoprotein), and triglyceride levels; and 4) weight loss. These findings demonstrate a positive effect of diet and exercise health education in combination with the behavioral modification strategy program on NIDDM patients.