背景

2型糖尿病患者出院后出现严重并发症的风险增加。基于网络的过渡护理是改善该患者组的血糖控制和生活质量的一种潜在的干预措施。然而，基于网络的过渡护理能否改善该组患者的血糖控制和生活质量仍然未知。此外，尚未充分探索干预与血糖控制和生活质量之间关系的潜在机制。

目标

这项研究的目的是开发一个基于网络的过渡护理计划，并评估其对中国2型糖尿病患者的血糖控制和生活质量的影响，并探讨自我效能和治疗依从性的中介作用。

设计

随机对照试验。

场所和参与者

这项研究是在中国广州市的一家大型地方医院中进行的。参与者为诊断为2型糖尿病的患者。

方法

共有116名合格参与者被随机分配接受为期3个月的基于网络的过渡护理计划或常规护理。在基线和3个月时评估血红蛋白A1c（HbA1c），自我效能，治疗依从性和生活质量。分析遵循意向性治疗原则。使用广义估计方程确定干预对HbA1c和生活质量的影响。使用路径分析来探索干预期间自我效能和治疗依从性的变化对这些影响的介导作用。

结果

与对照组相比，干预组的参与者在HbA1c（β= 2.87; p <0.01）和生活质量（β= 7.69; p <0.01）方面的改善显着更大。自我效能提高（间接作用：β= 0.18，p <0.05）和治疗依从性改善（间接作用：β= 0.17，p <0.05）显着介导了干预与血糖控制和生活质量之间的关系；总体而言，该模型解释了HbA1c变异的52.5％和生活质量变异的34.2％。

结论

我们的研究确定了基于网络的过渡护理计划对2型糖尿病患者出院后血糖控制和生活质量的有益影响，以及潜在的中介机制。这个基于网络的干预计划的有效性和可行性表明，应在社区环境中推广其应用，以减少2型糖尿病患者的不良预后。

 

 

Abstract

Background

Individuals with type 2 diabetes have a heightened risk of developing serious complications post hospital discharge. Web-based transitional care is a promising intervention to improve the glycemic control and quality of life of this patient group; however, whether web-based transitional care can improve the glycemic control and quality of life of this group remains unknown. Further, the mechanisms underlying the relationships between the intervention and both glycemic control and quality of life have not been fully explored.

Objectives

The aims of this study were to develop a web-based transitional care program and evaluate its effects on the glycemic control and quality of life of Chinese patients with type 2 diabetes and to explore the mediating roles of self-efficacy and treatment adherence.

Design

Randomized controlled trial.

Settings and participants

This study was conducted in a large regional hospital in Guangzhou City, China. Patients diagnosed with type 2 diabetes were included.

Methods

A total of 116 eligible participants were randomly assigned to receive either the 3-month web-based transitional care program or usual care. Assessments of hemoglobin A1c (HbA1c), self-efficacy, treatment adherence, and quality of life were conducted at baseline and at 3 months. Analysis followed the intention-to-treat principle. A generalized estimating equation was used to determine intervention effects on HbA1c and quality of life. Path analysis was used to assess the mediation of these effects by changes in self-efficacy and treatment adherence during the intervention.

Results

Participants in the intervention group had significantly greater improvements in HbA1c (β = 2.87; p < 0.01) and quality of life (β = 7.69; p < 0.01) compared with the control group. The relationships between the intervention and both glycemic control and quality of life were significantly mediated by improved self-efficacy (indirect effect: β = 0.18, p < 0.05) and improved treatment adherence (indirect effect: β = 0.17, p < 0.05); overall, the model explained 52.5% of the variance in HbA1c and 34.2% of the variance in quality of life.

Conclusions

Our study identified beneficial effects of a web-based transitional care program on glycemic control and quality of life post hospital discharge in people with type 2 diabetes, and the underlying mediating mechanisms. The effectiveness and feasibility of this web-based intervention program suggests that its application should be promoted in community settings to reduce poor outcomes in people with type 2 diabetes.

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0020748921000699