門診強化照護對血糖控制成效之初探

血糖控制不良的糖尿病患者，需要積極合理地控制血糖。糖尿病教育在病人學習糖尿病照護當中是一項很重要的介入措施。糖尿病照護有助於血糖控制，需要醫療團隊和病人共同努力來達成目標。本文主要探討血糖控制不良之糖尿病患者，門診接受強化糖尿病照護措施後對血糖控制的成效。採前瞻性介入前後三個月間之成效研究，於南部某一教學醫院之新陳代謝科門診，針對糖化血色素大於9%之糖尿病患者為研究對象，共收案1,393人。依據研究對象的意願分為接受一般診療和衛教組(n=736)和強化糖尿病共同照護組(n=657)。兩組研究對象於每個月回診時接受醫師診療和強化血糖控制衛教，而強化糖尿病共同照護組則再接受糖尿病共同照護網課程。結果發現兩組研究對象在接受措施後的第二個月和第三個月，糖化血色素值下降幅度最多為措施前糖化血色素大於11%族群之研究對象。門診強化糖尿病照護不僅可以幫助血糖控制不良的病人了解血糖的變化，更可以即時提供診療和衛教，協助病人合理地控制血糖。

關鍵字

糖尿病患者；糖化血色素；強化糖尿病照護；新陳代謝科門診

並列摘要

Active and targeted glycemic control is required in diabetes patients with poor glycemic control. Diabetes education is an important intervention to assist patients in understanding diabetes and glycemic control management. Diabetes management requires the medical team and patients to work together for achieving targets. The purpose of the study was to carry out a preliminary study in search of the effectiveness in enhancing glycemic control after implementing monthly outpatient diabetes care interventions in diabetes patients with poor glycemic control. This prospective study, conducted in an endocrinology and metabolism clinic in a teaching hospital in southern Taiwan, assessed the effectiveness of intervention by comparing data obtained in 3 months duration before and after the intervention. The study recruited diabetes patients with ＞9% glycated hemoglobin, and a total of 1,393 candidates were examined. The participants were divided into two groups (medical treatment and education only by physicians [n=736], medical treatment and education by both physicians and the diabetes shared care team [n=657]) with their permissions. After the participants received an outpatient diabetes care intervention, the decrease in glycated hemoglobin was anticipated. Regardless of whether the participants received medical treatment and education by physicians only or they received additional diabetes shared care program, the participants with a glycated hemoglobin ＞11% pre-intervention showed the glycated hemoglobin decreased rapidly at second months and third month of post-intervention. Outpatient intensive diabetes care helps patients with poor glycemic control in understanding blood glucose changes. It also provides immediate diagnosis, treatment, health education and assists patients controlling glycated hemoglobin.

並列關鍵字

patients with diabetes ； glycated hemoglobin ； intensive diabetes care ； endocrinology and metabolism clinic

參考文獻

吳淑靜、黃俊豪（2013）‧糖尿病共同照護對病患糖化血色素、健康信念與健康行為之影響‧台灣公共衛生雜誌，32(6)，537-550。doi: 10.6288/TJPH201332102054

陳都文、王俊毅（2009）‧糖尿病共同照護網對偏遠地區中老年患者健康狀況之成效‧台灣公共衛生雜誌，28(4)，334-343。doi:10.6288/TJPH2009-28-04-08

張富勝、吳南緯、洪禎澤、陳國寶、張倩淇、孫嘉成（2016）‧糖尿病衛教整合效益評價–某區域教學醫院經驗‧台灣家醫誌，26(3)，135-146。doi:10.3966/168232812016092603002

黃憶玫、張慈桂（2011）‧糖尿病照護成效與影響因素之探討：以台東某區域醫院糖尿病共同照護網為例‧台灣公共衛生雜誌，30(1)，19-28。doi:10.6288/TJPH2011-30-01-03

American Diabetes Association. (2017a). Glycemic targets. Diabetes Care, 40(1, Suppl.), S48-S56. doi:10.2337/dc17-S009

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門診強化照護對血糖控制成效之初探

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