A Study On Using Empowerment Theory To Change The Behavior Of Patients With Type 2 Diabetes And Impaired Glucose Regulation

Backgrounds:Diabetes mellitus is a kind of seriously harmful disease.The prevalence of this chronic metabolic disease is increasing with the economic development especially in developing countries.Globally,the figure for the people with diabetes is said to have risen from 30 million in 1985 to 143 million in 2000.It is estimated that in the year 2010 it will be 220 million and 300 million in 2025.As we know,type 2 diabetes mellitus(T2DM) is associated with inactive life style.So it is very important to change lifestyle and decrease the risk factors of diabetes.Objective:1,To recheck participants who's are 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L and have no previous diagnosis of diabetes on the basis of 1500 health check-up cadres in Jinan Central Hospital to clear diagnose and prevention timely.2,The participants(IGR and DM) were given the course of education for patient empowerment during 1 year to change their lifestyle and decrease the risk factors of diabetes.3,To find out the correlation between adiponectin levels and the risk factors of diabetes among people with T2DM,IGR and normal glucose tolerance.After the education for patient empowerment,adiponectin level rises,FBG,BMI,TG,BP,WHR improved obviously.Object and Methods:1.Objects54 patients were selected out according to the IF6 diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres in Jinan Central Hospital from September to December in 2006 except the patients who had diabetes history to carry out the OGTT text,28 of them were diagnosed diabetes, of whom 27 were male and 1 was female with the average age 53.43±5.30, the average height 171.96±4.96 cm.26 of these 54 patients were diagnosed IGR(17 IGT and 9 IFG),of whom 23 male and 3 female with the average age 54.93±6.09 and the average height 171.82±5.67cm.All the 54 patients who were first diagnosed with diabetes and the IGT,IFG patients were give the course of education for patient empowerment.2.MethodsThe patient were given education for patient empowerment for 1 year and the courses are divided the five steps:identify the problems; explore feelings;set up goals;make plans;evaluate the results.All the steps are needed.Height,weight,blood pressure,waist circumference,hip circumference,fasting blood glucose,blood lipids(TC,TG,HDL-C,and LDL-C)and uric acid were included in the items of health check-up in 2006. We used ELISA to measure the adiponectin of the 54 patients and 31 normal persons After and before the 1 year course.The 54 patients were rechecked from September to December in 2007 and the checking items were same as 2006.The result was used to evaluate the effect of the course.3.Statistical analyses:All data were analyzed by SAS 8.2 software.Before statistical analyses Skew variables(TG,FBG and Adiponectin) were transformed to normalize their distribution.The numerical data were expressed as mean±SD and analyzed by t-test analysis,Chi-squared test,x~2 test and Pearson according to different aims.A threshold for significance was set as P＜0.05.Results:1.From Table 1-1～4 show that before education for patient empowerment in 2006 there was statistic meaning for the difference among DM,IGR and NC group(p＜0.0001).From the comparing the three group after education for patient empowerment in 2007 could be seen Adiponectin concentrations of NC,IGR group were significantly higher than DM group(P=0.00131).2.From Table 2-1～2 show that before education for patient empowerment the Adiponectin and TG in DM group had a moderate negative correlation. After education for patient empowerment Adiponectin in NC and IGR had a low negative correlation with weight and TG,and had a low positive correlation with HDL-C.3.From Table 3-1～2 show that after 1 year education for patient empowerment there was evident improvement in FBG,systolic pressure,diastolic pressure,weight,BMI and WC between two years in IGR group(P＜0.05).There was evident improvement in Adiponectin between two years in IGR group(p＜0.0001).There was statistical difference of FBG, weight,BMI,UA,WC,WHR between two years in DM group(P＜0.05).There was statistical difference of Adiponectin between two years in DM group (p＜0.0001).4.From Table 4-1～4 show that abnormal blood level in 2007 decreased significantly than in 2006.High TC ratio were evidently decreased(P= 0.0023).High UAratio were evidently decreased(P=0.0114).WHR ratio fell in 2007 than in 2006(P=0.0348).5.From Table 5 show that after 1 year education for patient empowerment there were 13 items changed evidently among 15 behavior items.Conclusions:1.According to the IFG diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres,positive intervention can significantly improve the detection rate of the IGR and diabetes which can avoid undiagnosis of the diabetes.2.The empowerment of diabetes education can correct the controlled unhealthy lifestyle initiatively and achieve the goal of behavior change.3.FBG,BMI,TG,BP,WHR and other risk factors have been significantly improved.Adiponectin have been significantly risen.These factors could reverse and improve diabetes better.