運用看圖對話工具提升衛教糖尿病患自我血糖控制

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

陳靜雯(Ching-Wen Chen) ； 陳世爵(Shih-Chueh Chen) ； 林幸宜(Hsing-Yi Lin) ； 賴金蓮(Chin-Lien Lai) ； 曾靜薇(Ching-Wei Tseng) ； 柯佳宜(Chia-I Ko) ； 鄭彩雲(Tzu-Hsin Lee) ； 李慈馨(Tsai-Yun Cheng)

《澄清醫護管理雜誌》 11卷4期 (2015/10) Pp. 20-26

摘要

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。

關鍵字

糖尿病看圖對話 ； 糖尿病 ； 糖化血色素 ； 血糖自我監測

並列摘要

PurposesUsing 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.MethodsThis 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.ResultsOn 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±18.7mg/dl (p=0.16), and post prandial blood glucose, on average, decreased 24.7±45.3mg/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±38.1mg/dl (p=0.008), and BMI, on average, decreased 0.4±0.4kg/m^2(p＜0.001).ConclusionsThe 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.

並列關鍵字

Diabetes Conversation Map ； Diabetes ； HbA1c ； Self-Monitoring of blood glucose