第二型糖尿病預防的策略與運用

Strategy and Practice in the Prevention of Type-2 Diabetes

第二型糖尿病是台灣常見的慢性疾病，而且好發心臟血管、腎臟與神經系統之合併症，因此也是台灣十大死因第四位。由於糖尿病患者的花費佔所有健保醫療費用的11.5%，因此健保局也開始關注糖尿病預防等相關課題。根據許多文獻及研究顯示實施第二型糖尿病預防政策之成效遠超過早期診斷與治療。因此本篇文章將介紹一套本土化，運用於糖尿病高危險群的「健康生活型態促進」之個案管理方案－－「智慧生活家」的策略與運用，內容是以身體活動、飲食及行為修正之方式來改變個案的生活型態，而且透過個案管理師的諮詢與追蹤，與量身訂作且容易遵循的設計，促使個案達到或維持所設定的目標。並期許藉由落實第二型糖尿病的預防，未來不但能降低全民的醫療資源沉重負擔，更能促進糖尿病高危險群獲得最佳的生活品質。

In Taiwan, Type 2 diabetes is a common chronic disease and a major cause of mortality because of the adverse complications with which it afflicts the cardiovascular, renal and neurological systems. The Bureau of National Health Insurance has begun to address issues of diabetes prevention. Statistics indicate that patients with diabetes account for 11.5% of all medical expenditure by this Bureau. Evidence from the literature suggests that a policy of prevention ought to be more effective than the early detection and treatment of diabetes. This paper recommends a case management system that is sensitive to Taiwan culture and involves the promotion of a healthy lifestyle, ”the LOHAS executants”, to promote efficient strategies and interventions for the prevention of diabetes. The focus of the approach is one of a gradual change in an individual's lifestyle, including physical activity, a healthy diet and behavior modification. Adherence to the interventions is determined through consultation and monitoring by a case manager. All procedures are tailored and kept convenient, in order to help the participants to achieve or maintain their goals. Overall, in the future, the prevention of type 2 diabetes in high-risk individuals will reduce the tremendous burden on national medical resources created by this disease, and help those people to develop an optimal quality of life.