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論文名稱(中文) 新科技對中老年糖尿病患之影響:連續血糖監測即時回饋與延遲回饋對血糖控制、自我效能之綜合評估
論文名稱(英文) Evaluation of glycemic control and self-efficacy among patients receiving continuous glucose monitoring with immediate counseling feedback compared with delayed counseling feedback
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 106
學期 1
出版年 107
研究生(中文) 杜業豐
研究生(英文) Ye-Fong Du
學號 TC6021073
學位類別 碩士
語文別 英文
論文頁數 91頁
口試委員 召集委員-楊宜青
指導教授-邱靜如
口試委員-歐弘毅
中文關鍵字 連續血糖監測  第二型糖尿病  中老年人 
英文關鍵字 continuous glucose monitoring  type 2 diabetes  middle aged and older adults 
學科別分類
中文摘要 研究目的
連續血糖監測可完整顯示病人血糖起伏的全貌。本研究探討以專業型連續血糖監測進行諮詢衛教,加強中老年糖尿病患對自身血糖變化的了解,是否可改善血糖控制、自我效能及自我管理行為,另探討即時回饋或延遲回饋在介入成效上是否不同。
研究方法
本研究收納17位預計接受連續血糖監測的45歲以上第二型糖尿病人,糖化血色素在7%以上,隨機分派進入即時回饋(n=7)與延遲回饋組(n=10)。即時回饋組於拆機當天由同一位醫師進行諮詢衛教,延遲回饋組於三個月回診日由原看診醫師進行諮詢衛教。病患在接受連續血糖裝機前、檢查三個月及六個月後會接受問卷訪談,藥物調整記錄、手寫飲食記錄並照相,及運動手錶的佩戴。飲食內容由營養師對照日誌及照片進行成份分析,運動量由電腦輸出觀察介入前後的變化。
研究結果
即時回饋組相較於延遲回饋組於三個月追蹤有較低的憂鬱分數(p=0.024),及較好的自我效能(p<0.001)。即時回饋組相較於收案前,糖化血色素於三個月追蹤時有改善(p=0.03)。延遲回饋組於諮詢後三個月糖尿病壓力與收案前相比亦有顯著下降(p=0.018)。但各項指標改變的幅度在兩組間無顯著差異。即時回饋組的糖化血色素於六個月追蹤時與收案前相比無顯著差異。
研究結論
專業型連續血糖監測需配合即時回饋,才能短期改善血糖控制。
英文摘要 OBJECTIVE
The whole picture of glycemic excursions could be revealed by continuous glucose monitoring (CGM) thoroughly. This study is designed to explore the effect of feedback counseling using professional CGM on glycemic control, self-efficacy, and self-management behaviors among middle aged and older adults with poor controlled type 2 diabetes mellitus. This study also explores the difference on timing of feedback after CGM exam.
METHOD
This study enrolled patients aged 45 years and older with HbA1c more than 7%. Participants were assigned into immediate feedback (n=7) or delayed feedback (n=10) groups using 4-block randomization design. The immediate feedback group received counseling using CGM graphs on the day of sensor removal by the same investigator. The delayed feedback group received CGM-based counseling 3 months later as usual care schedule by their primary care physicians. Semi-structured questionnaires, drug adjustment records, diet diary including photos, and physical activities measured by fitness bracelet were evaluated at baseline, 3 months, and 6 months follow-up. Diet composition was analyzed by the same registered dietitian. Physical activity levels were downloaded from Fitbit Web site.
RESULTS
Participants received immediate feedback had lower depression scores (p=0.024) and better self-efficacy score (p<0.001) at 3 months, compared with delayed feedback group, and a better HbA1c level compared with baseline (p=0.03). Participants at delayed feedback group had an improved score for diabetes emotional burden (p=0.018) at 6 months compared with baseline. There was no difference between groups, assessing change of all outcome measures at 3-months after CGM-based feedback counseling. The beneficial effect for glycemic control at immediate feedback group was lost at 6-months follow-up.
CONCLUSION
Professional CGM had potential benefit in improving glycemic control, and self-efficacy especially if feedback counseling was carried out immediately after sensor removal.
論文目次 Chapter 1 Introduction 1
SECTION 1.1 BACKGROUND 1
SECTION 1.2 PURPOSE 3
Chapter 2 Literature Review 4
SECTION 2.1 IMPORTANCE OF SELF-MANAGEMENT ON DIABETIC CONTROL 4
SECTION 2.2 ASPECTS ASSOCIATED WITH SELF-MANAGEMENT 5
2.2.1 Self-efficacy 5
2.2.2 Drug and diet compliance 6
2.2.3 Depression 6
2.2.4 Diabetic associated emotional stress 6
2.2.5 Family support 7
SECTION 2.3 QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS 7
SECTION 2.4 APPLICATION OF CONTINUOUS GLUCOSE MONITORING IN DIABETIC CONTROL 8
Chapter 3 Method 10
SECTION 3.1 PARTICIPANTS AND RECRUITMENT 10
SECTION 3.2 MEASUREMENT 15
3.2.1 Demographic and clinical variables 15
3.2.2 Anthropometric measurement 15
3.2.3 Blood tests 15
3.2.4 Problem Areas in Diabetes (PAID) Questionnaire 16
3.2.5 Center for Epidemiologic Studies Depression (CESD-R) Scale 16
3.2.6 Stanford Self-Efficacy for Diabetes Scale (SES) 17
3.2.7 Twelve-item Short Form Health Survey version 2 (SF-12v2) 17
3.2.8 Diabetes Family Behavior Checklist subscale (DFBC-II) 17
3.2.9 Diet composition evaluation 18
3.2.10 Physical activity level evaluation 18
SECTION 3.3 INTERVENTION 19
SECTION 3.4 STATISTICAL ANALYSIS 20
Chapter 4 Result 21
SECTION 4.1. BASELINE CHARACTERISTICS AND DEMOGRAPHIC OF ALL PARTICIPANTS. 21
SECTION 4.2. EFFECT OF CGM COUNSELING ON GLYCEMIC CONTROL AMONG MIDDLE AGED AND OLDER ADULTS WITH TYPE 2 DIABETES 23
SECTION 4.3. COMPARISON FOR EFFECT OF IMMEDIATE CGM FEEDBACK COUNSELING WITH SELF-MEASURED BLOOD GLUCOSE ON OUTCOME MEASURES. 31
SECTION 4.4. COMPARISON FOR EFFECT OF IMMEDIATE CGM FEEDBACK COUNSELING WITH DELAYED FEEDBACK COUNSELING ON OUTCOME MEASURES. 42
SECTION 4.5. EVALUATION OF 6 MONTHS EFFECT FOR CGM-BASED COUNSELING 51
SECTION 4.6. ANALYSIS OF MODERATING FACTORS IN MEDIATING GLYCEMIC CONTROL RESULTS. 59
Chapter 5 Discussion 62
SECTION 5.1. EFFECT OF CGM COUNSELING ON GLYCEMIC CONTROL -PROFESSIONAL CONTINUOUS GLUCOSE MONITORING AS A COMMUNICATING MATERIAL 63
SECTION 5.2. PROFESSIONAL CONTINUOUS GLUCOSE MONITORING IN COMPARISON WITH SELF-MEASURED BLOOD GLUCOSE 66
SECTION 5.3. IMPORTANCE FOR TIMING OF CGM COUNSELING - IMMEDIATE FEEDBACK VERSUS DELAYED FEEDBACK 68
SECTION 5.4. EFFECTS OF SINGLE COURSE OF CGM COUNSELING IS NOT LONG LASTED 69
SECTION 5.5. LIMITATION 70
SECTION 5.6. CONCLUSION 71
Reference ...........72
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