探討營養衛教介入對糖尿病合併有心血管疾病患者之影響

Effects of nutritional education intervention on patients with diabetes and cardiovascular disease

黃靖雅(Jing-Ya Huang)

指導教授 ： 徐成金

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00026

摘要

本研究以中部某區域教學醫院之新陳代謝科門診中有加入糖尿病共同照護網之患者為對象，主要目的在了解糖尿病門診營養教育的介入，對於同時合併高血壓或高血脂的糖尿病病人，對於糖尿病的控制及其他大小血管併發症相關危險因子的影響。
研究對象為18歲以上，經醫師診斷有第二型糖尿病及合併有高血壓或高血脂等心血管疾病診斷者，排除罹患惡性腫瘤者及孕婦，於研究期間為首次接受營養衛教諮詢門診，並完成每三個月追蹤一次，共四次的營養衛教。
結果發現，對所有研究對象而言，經過此為期一年的營養衛教之後，有顯著的：(1)總攝取熱量減少5%；(2)糖化血色素下降0.5%；(3)低密度脂蛋白下降9 mg/dL以及總膽固醇下降8 mg/dL；(4)舒張壓下降5 mmHg；(5)體態改變(腰圍、臀圍下降)。
藉由以上相關因子的改善，使得糖尿病獲得較好的控制，且能更進一步的改善心血管疾病的危險因子，進而降低心血管疾病的發生風險。

關鍵字

營養衛教 ； 糖尿病 ； 高血壓 ； 血脂異常

並列摘要

This study enrolled the patients who joined the Diabetes Shared Care System in a regional teaching hospital in central Taiwan. The aim of this study was to evaluate the effect of nutritional education toward the diabetic patients combined with hypertension or dyslipidemia on the control of diabetes and the risk of related macro- and microvascular complications.
The participants were adults aged equal or more than 18 years old with the diagnosis of type 2 diabetes mellitus and cardiovascular disease such as hypertension or dyslipidemia. Cancer patients and pregnant patients were all excluded. The participants received his or her first time outpatient nutritional education and completed the one-year surveillance with outpatient visits and nutritional education every three month.
The results showed that for all patients in this study, after the four times nutritional education, there were significant improvements in the following parameters: 5% lowering of total energy intake,0.5% reduction of HbA1c, 9mg/dL decreasing of low density lipoprotein and 8mg/dL decreasing of total cholesterol, diastolic blood pressure, waist and hip circumference.
Contributed to the improvement of the factors, the control of diabetes and the cardiovascular risk factor could be further improved.

並列關鍵字

nutritional education ； diabetes mellitus ； hypertension ； dyslipidemia

參考文獻

汪宜靜，莊立民等。糖尿病人飯後血糖的管控。中華民國糖尿病衛教學會會訊 2014；10(3),15-19.

行政院衛生署全民健康保險醫療統計年報，網站來源：http://mohw.gov.

盧佳怡等。基礎胰島素治療第2型糖尿病患之療效。北市醫學雜誌； 8 卷4期 2011；P21-28.

American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33(supplement 1):S62-S69.

American Diabetes Association. Standards of Medical Care in Diabetes-2012. Diabetes Care. 2012;35(supplement 1):S11-S63.