| 刘晓娜,夏庆华,方红,李锐,陈英耀,严玉洁,周鹏,姚保栋,姜玉,Russell L Rothman,徐望红.健康素养及运动干预控制糖尿病患者血糖水平的效果评估[J].中华流行病学杂志,2018,39(3):357-362 |
| 健康素养及运动干预控制糖尿病患者血糖水平的效果评估 |
| Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China |
| 收稿日期:2017-06-20 出版日期:2018-03-21 |
| DOI：10.3760/cma.j.issn.0254-6450.2018.03.021 |
| 中文关键词: 糖尿病,2型 糖化血红蛋白 健康素养 运动 干预 |
| 英文关键词: Diabetes,type 2 Hemoglobin A1c Health literacy Exercise Intervention |
| 基金项目:美国中华医学基金会（CMB）公开竞争项目（13-159）；教育部人文社科规划基金（14YJAZH092） |
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| 中文摘要: |
| 目的 评估健康素养及运动干预降低2型糖尿病（T2DM）患者血糖水平的效果。方法 以上海市闵行区和长宁区799名最近一次糖化血红蛋白（HbA1c）≥ 7.5%（或FPG≥10 mmol/L）的T2DM患者为研究对象，采用整群随机分组方法分为健康素养干预组、运动干预组、综合干预组（健康素养＋运动干预）和对照组，每组各约200人。基线调查、身体测量及生化检测完成后，各干预组分别接受为期1年的干预。第3、6和12个月时，对所有患者进行问卷调查随访、身体测量和HbA1c检测。结果 3、6和12个月时患者的总应答率分别为99.4%、98.4%和95.2%。干预满3个月时，综合干预组HbA1c达标率（HbA1c<7.0%）最高，为25.3%，6和12个月时运动干预组达标率最高，分别为25.3%和34.6%。与基线时相比，各干预组HbA1c值在不同随访时段均有下降，以6个月时最明显，综合干预组平均下降0.48%（95% CI：-0.71%～-0.25%），健康素养干预组下降0.33%（95% CI：-0.55%～-0.11%），运动干预组下降0.70%（95% CI：-0.92%～-0.48%），而对照组略升高0.03%（95% CI：-0.19%～0.25%），差异有统计学意义（P<0.001）。以对照组为参比，调整可能的混杂因素后，3个月时综合干预组HbA1c效果最佳（β=-0.47，95% CI：-0.73～-0.20）；随后运动干预的效果逐渐凸现，6和12个月时HbA1c降幅分别达-0.73（95% CI：-0.98～-0.47）和-0.75（95% CI：-1.05～-0.45）。分层分析显示，在健康素养较低的患者中3种干预手段均有效，而在算术能力高者中运动干预更为有效。结论 健康素养及运动干预均可有效降低上海市社区T2DM患者的HbA1c水平，这将有助于降低患者并发症的发生和早死风险。 |
| 英文摘要: |
| Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China. Methods In this cluster randomized controlled trial, a total of 799 T2DM patients with most recent hemoglobin A1c (HbA1c) ≥ 7.5% (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai, and randomized into a health literacy intervention group, an exercise intervention group, a comprehensive intervention group and a control group. After baseline survey and examination, a one-year intervention and 3 times (at 3rd, 6th, and 12th month) follow-up surveys were conducted. Results The follow-up rates for all the subjects were 99.4%, 98.4% and 95.2%, respectively, at 3rd, 6th and 12th month. Patients in intervention groups were more likely to achieve a goal HbA1c level (HbA1c < 7.0%) than those in control group, with the highest glycemic control rate (25.3%) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3% and 34.6%) respectively, at 6th month and 12th month. The average levels of HbA1c in three intervention groups were lower at each follow-up time point than those at baseline survey. However, the decreases in HbA1c were obvious only at 6th month (P<0.001), with ls-mean (95%CI) of -0.48% (-0.71%, -0.25%), -0.33% (-0.55%, -0.11%) and -0.70% (-0.92%, -0.48%), respectively, in comprehensive, health literacy and exercise intervention groups, but it increased slightly by 0.03% (-0.19%, 0.25%) in control group. Compared with control group, the interventions were significantly associated with the decrease of HbA1c level, with the most improvement observed in comprehensive group (β=-0.47, 95%CI:-0.73, -0.20) at 3rd month, and in exercise intervention group at 6th month (β=-0.73, 95%CI:-0.98, -0.47) and at 12th month (β=-0.75, 95%CI:-1.05, -0.45) of follow-up. Stratified analyses showed that patients with lower health literacy level could benefit from any intervention, while those with higher numeracy skill benefited more from exercise intervention. Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM, which would be helpful in reducing the risks of complications and deaths in diabetes patients. |
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