糖尿病對話卡與團體衛教介入對第二型糖尿病注射基礎型胰島素病人血糖控制成效之探討

Diabetes Education Intervention for Type 2 Diabetic Patient with Basal Insulin Therapy

目的：本研究旨在探討注射基礎型胰島素之第二型糖尿病病人以積極的衛教介入三個月之照護品質成效。方法：採介入性研究設計，共收集取樣150位糖尿病病人，分配糖尿病對話卡組和一般常規衛教組，糖尿病對話卡組須參加至少一次糖尿病對話卡團體衛教和三個月的電訪追蹤，一般常規衛教組僅一般常規回診時衛教室追蹤，為期一年的追蹤來評估兩組介入前後身體質量指數、血壓、糖化血色素、空腹血糖、血清肌酸酐和低血糖頻率等變化。結果：比較兩組各75人在追蹤三個月和追蹤十二個月其糖化血色素皆有改善，以ANCOVA分析兩組呈現統計上顯著差異(p<0.05)，但身體質量指數和血壓皆無統計上顯著差異。另外，比較兩組於追蹤一年期間皆持續施打基礎型胰島素合併口服降血糖藥物的病人時，兩組各43人在追蹤三個月時糖化血色素有統計上顯著差異(p<0.05)，但追蹤十二個月卻無顯著差異。結論：糖尿病病人無論是團體衛教或是一般衛教都有助於降低糖化血色素，團體衛教積極介入效果更是顯著，建議未來針對胰島素注射病人宜強調衛教課程和電訪的介入，以讓糖尿病照護更有效益。

Background: This study was designed to investigate the effectiveness of implementing a structured education for the patients who started on basal insulin. Methods: A total of 150 participants were enrolled for this study and allocated into either an intervention or a control group. Participants in the intervention group were required to attend at least one diabetes group education session using interactive dialogue cards; those in the control group received routine care provided at an outpatient clinic. Body mass index, blood pressure, glycated hemoglobin (HbA1c), fasting blood glucose, serum creatinine, self-monitoring blood glucose frequency were evaluated before and after intervention at 3, 6 and 12 months. Results: Compared to their counterparts in the control group, participants in the intervention group reported a greater decrease in HbA1c. There was a greater proportion of patients receiving intensification of insulin therapy in the intervention group. No difference, however, was observed between the two groups in terms of changes in body mass index and blood pressure. Conclusion: Results of the study indicate that interactive group education helps patients who just start receiving insulin therapy strengthen glycemic control. Interventions in the forms of group education and telephone follow-up should therefore be provided for patients with basal insulin therapy.