[ADA2013]OPENING研究:结构化教育改善患者的自我管理能力和依从性
发布时间：2013-06-28 | 来源：医脉通
关键词：
结构化教育
糖尿病教育
OPENING研究
ADA2013
【导语】2013年第73届美国糖尿病协会科学年会(ADA2013)于6月21日~25日在美国芝加哥隆重举办，在ADA2013年会上，北京大学第一医院纪立农教授有5篇中国研究入选壁报讨论(2篇 General Poster Sessions)和会议摘要(3篇 Published Only)。其中一篇壁报的题目为“OPENING研究：评估患者的自我管理、自我照顾能力以及药物依从性”，研究结果显示，结构化教育能够改善2型糖尿病患者的自我管理、自我照顾能力以及药物依从性。以下是医脉通对相关内容的翻译整理。
目的：糖尿病和胰岛素管理研究(OPENING)旨在评价经结构化教育的糖尿病患者的自我管理、自我照顾能力以及药物依从性。
方法：纳入对两种口服降糖药物失效的18岁以上的糖尿病患者(糖化血红蛋白>7.5%)。随机1:1分入教育组(结构化教育加上胰岛素治疗)和对照组(普通教育加上胰岛素治疗)。结构化教育由受训的护士使用7种OPENING教育工具完成，包括药物、胰岛素注射、血糖监测技术、饮食、体育锻炼、低血糖预防和并发症预防。使用中国版糖尿病自我管理效能工具(C-DMSES)、糖尿病自我照顾活动工具(SDSCA)和Morisky 药物依从性工具(MMAS)来评价患者的自我管理、自我照顾能力以及药物依从性。
结果:从中国48间医院共纳入1511名糖尿病患者，共有1289名患者完成研究，教育组646人，对照组643人。在16周之后，两组C-DMSES总的评分均升高，教育组高于对照组(13.87±31.00 vs. 20.27±33.17 P<0.0001)。两组中MMAS高依从性患者的比例均较基线时升高(P<0.0001 vs. 基线)。教育组的药物依从性更高 (74.53% vs. 62.99% P<0.05) 。
结论：结构化教育能够改善2型糖尿病患者的自我管理、自我照顾能力以及药物依从性。
【研究摘要】
Evaluation of Self-Management Self-Care Ability and Medication Adherence In OPENING (Organization Program of DiabEtes INsulIN ManaGement) Study
Linong Ji MD, Peking University
Purpose: Organization Program of DiabEtes INsulIN ManaGement (OPENING) study was designed to evaluate the self-management self-care ability and medication adherence in T2DM patients managed with structured education.
Methods: Eligible patients were over 18 years of age and inadequately responded to two or more OADs for over 3 months (HbA1c% >7.5%). Patients were randomized (1:1) into education group (structured education plus insulin therapy) and control group (usual care plus insulin therapy). Structured education was conducted by trained nurses with OPENING education tool which included seven models as medications insulin injection technique BG monitoring diet physical activity hypoglycemia prevention and complication prevention. Chinese version Diabetes Management Self-efficacy Scale (C-DMSES) Summary of Diabetes Self-Care Activities Scale (SDSCA) and Morisky Medication Adherence Scale (MMAS) were used to assess patients’ ability of self-management self-care and medication adherence respectively.
Results: Totally 1511 patients with T2DM were enrolled from 48 hospitals across China. Of the 1289 patients who completed this study 646 were in education group and 643 in control group. After 16-week the total score of C-DMSES increased in both group and significantly higher in education group(13.87±31.00 vs. 20.27±33.17 P<0.0001). The total score of SDSCA increased in both group and significantly greater in education group(10.50±16.07 vs. 6.97±14.63 P<0.0001). Propotion of patients with high adherence in MMAS has increased in both groups(P<0.0001 vs. baseline). And education group had a higher proportion of high compliance (74.53% vs. 62.99% P<0.05).
Conclusions: Structured education can improve the ability of self-management and self-care in patients with type 2 diabetes meanwhile enhance their medication adherence.
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