探討糖尿病共同照護於慢性阻塞肺病合併第二型糖尿病人之代謝指標成效

Efficacy of a Diabetes Shared Care Program on Metabolic Index for Chronic Obstructive Pulmonary Patients with Type 2 Diabetes Mellitus

目的：糖尿病和慢性阻塞肺病，是高罹病率且死亡率偏高之慢性病。實證指出慢性阻塞肺病病人容易罹患糖尿病。糖尿病共同照護有效管理糖尿病人血糖和延緩併發症發生。本研究探討糖尿病共同照護於慢性阻塞肺病合併第2型糖尿病病人HbA1C、TG及LDL差異。方法：描述性追蹤比較研究，立意取樣，於胸腔專科醫院進行資料收集，共收案112人。分加入組(n=53)與未加入組(n=49)，兩組均接受慢性阻塞肺病疾病衛教，加入組提供糖尿病共同照護，於加入前、加入後第3個月及第6個月測量HbA1C、TG及LDL。結果：基本人口學中，除抽菸及常規運動達顯著差異(p<0.05)，其餘皆未達統計顯著差異(p>0.05)。兩組代謝指標改變量，除HbA1C達顯著差異(p<0.05)，LDL及TG均未達顯著差異(p<0.05)；在考量抽菸及常規運動變項對結果影響，組別與時間交互結果，HbA1C及TG達顯著差異(p<0.05)、LDL未達顯著差異(p>0.05)，複迴歸模型分析結果，只有HbA1C，達到正向有效控制(p<0.05)，LDL及TG未達顯著差異(p>0.05)。結論：糖尿病共同照護有助於慢性阻塞肺病合併第2型糖尿病病人HbA1C、TG控制。但是LDL控制並無明顯改善，與追蹤時間太短及服用降血脂藥物可能有關。本研究也發現兩組在人口群比較，採取正向健康行為如未抽菸、每日運動習慣族群加入組多於未加入組，彰顯鼓勵加入糖尿病共同照護重要性。從我們的研究結果顯示，糖尿病共同照護可以作為慢性阻塞肺病疾病管理輔助照護資源，進而為慢性阻塞肺病合併第2型糖尿病病人提供巨大的益處。

Objectives. Diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality. They often appear co-morbidly. Diabetes shared care programs can promote appropriate sugar intake and delay diabetes complications. The aim of this study was to compare the effects of diabetes shared care on metabolic status (HbA1c, LDL, and TG) in COPD patients with Type 2 Diabetes Mellitus (T2DM).
Methods. We performed a follow-up study of patients conveniently sampled in a chest hospital. In total, we invited 112 COPD patients with T2DM regularly visiting outpatient chest clinic to participate in this study. They were divided into two groups；those who joined a shared care program (n=53) and those who did not (n=49). HbA1c, LDL, TG were collected at the time of recruitment, at 3 months, and 6 months after they joined shared care program.
Results. Although we found significant differences in smoking and regular exercise (p<0.05), most of the changes in the remaining outcome variables did not reach significance (p>0.05). While we found a significant difference in HbA1C levels (p<0.05), we found no difference in LDL and TG (p>0.05). When analyzing base on group and time interaction results where smoking and regular exercise were controlled, we found significant difference in HbA1C and TG (p<0.05), but not LDL. Multiple regression analysis, however, revealed a significant positive effect on HbA1C (p<0.05), but not LDL or TG (p>0.05).
Conclusion. A shared care program could decrease HbA1C, TG and LDL in COPD patients with comorbid T2DM. Patients should be encouraged to join such programs and adopt, positive health behaviors including quitting smoking and regular exercise. Such a program could be offered as supplementary for COPD patients with T2DM.