運用看圖對話工具提升衛教糖尿病病患自我血糖控制

Improvements in Self-Management of Blood Sugar Using Diabetes Conversation Mapping Tools in Type 2 DM

目的：本研究目的針對第二型糖尿病患，藉由健康互動公司研發的「糖尿病看圖對話」的工具與對話教學模式，引起學員之學習樂趣和動機，進而有效的管理血糖以促進健康。方法：採縱向研究法，收集資料為在新陳代謝科就醫的第二型糖尿病患糖化血色素大於7％以上的個案共45人，上課以「糖尿病看圖對話」其中的二個課程，以前後測的方式評估病人知識瞭解程度及生化檢驗值的變化，統計方式採取雙尾配對t-檢定（paired-t test）方式。結果：本研究結果顯示「糖尿病看圖對話」中「與糖尿病同行」的前後測平均分數共提升7.3±0.1分（p<0.001），「健康飲食和運動」的前後測平均分數共提升7.3±0.7分（p<0.001），在健康識能有顯著的差異。上課飯前血糖平均值共下降9.4±18.7mg/dl（p=0.16），上課飯後兩小時血糖平均值共下降24.7±45.3mg/dl（p=0.049），六個月後的追蹤，平均糖化血色素共下降2.2±1.0mg/dl（p<0.001），血清總膽固醇值共下降37.2±23.4mg/dl（p<0.001），血清三酸甘油脂共下降123.8±38.1mg/dl（p=0.008），身體質量指數BMI共下降0.4±0.4kg/m2（p<0.001），都有顯著的改善，並已經排除有藥物調整的個案。結論：本研究結果顯示有參與「糖尿病看圖對話」的病患，病友主動參與討論所獲得的知識和同儕影響力，而且對於血糖、血脂及體重的控制有明顯的進步。

Purposes: Using diabetes conversation mapping tools and conversation models for “healthy interactions Inc.”, this research aims to motivate type 2 diabetes patients with meaningful learning experiences. This method also attempts to improve health and blood glucose management by increasing healthcare awareness and self-management capabilities among patients. Methods: This longitudinal study was conducted in the endocrinology department of a teaching hospital in Taichung using type 2 diabetes patients (HbA1c over 7%) as participants. Diabetes conversation mapping lessons include two topics. With the aim of improving selfcare capabilities and quality, we conducted pretests, posttests, and biochemical analyses. A two-tailed paired t-test was used to for statistics. Results: On average, the score of “living with diabetes” increased 7.3 ± 0.1 (p<0.001) and “healthy diet and exercise”increased 7.3 ± 0.7(p<0.001). This shows a significant improvement in overall healthcare awareness. The fasting blood glucose for participants in two classes, on average, decreased 9.4 ± 18.7 mg/dl (p=0.16), and post prandial blood glucose, on average, decreased 24.7 ± 45.3 mg/dl (p=0.049). Six-month tracking with biochemical analysis showed tangible improvements,adjusted to exclude drugs: HbA1c, on average, decreased 2.2 ± 1.0% (p<0.001), cholesterol, on average, decreased 37.2 ± 23.4mg/dl, triglyceride, on average, decreased 123.8 ± 38.1 mg/dl (p=0.008), and BMI, on average, decreased 0.4 ± 0.4 kg/m2(p<0.001). Conclusions: The study shows that patients participating in the diabetes conversation map, with knowledge and peer influence in discussion, significantly improved their blood glucose and blood lipid readings.