| BackgroundWith China’s rapid economic development, the westernized lifestyle, the aging population, and the rising rates of obesity, the prevalence of diabetes also showed a rapid growth trend. Survey of Chinese Diabetes Society released in 2010 showed that the type 2 diabetes (T2DM) prevalence rate in Chinese adults with the age of over 20 is 9.7%, prevalence rate of pre-diabetes is more than 15.5%, more importantly, there are about 60% of patients with undiagnosed diabetes, and for those patients undergoing treatment to control diabetes, the effect is also far from ideal. Long-term metabolic disorders of carbohydrates, fat, and protein can cause multi-system damage, resulting in eyes, kidneys, nerves, heart, blood vessels and other tissues chronic organ disease, dysfunction and failure; acute metabolic disorders, such as diabetic ketoacidosis, may occur at the moment of severe or acute stress, and therefore, prevention and control of diabetes is in urgent need. On average 10% to 15% of impaired glucose tolerance (IGT) patients without interventions become T2DM per year, thus, the IGT has the same or similar hazards as diabetes. Therefore, effective interventions in the early stage of IGT to reduce its incidence become critical to diabetes.ObjectivesTo investigate influence of the systematic health education on prognosis of IGTResearch dataAccording to the inclusion criteria and exclusion criteria, according to the IGT diagnostic criteria of WHO in 1999, plasma glucose of oral glucose tolerance test 2 hours (OGTT 2 hPG) is larger than 7.8 mmol/L and less than 11.1 mmol/L. There are 86 cases of IGT patients during the August to November in 2011 from the outpatient and the community health education for diabetes screening. According to the will of the patients and the objective cause,50 IGT patients could receive systematic health education was classified as the health education group and 36 IGT cases failed to receive systematic health education was classified as the control group. At the baseline, there are no significant difference between the two groups in age, sex, body mass index and fasting plasma glucose (FPG),2 HPG OGTT and glycosylated hemoglobin (GHbAlc) (P> 0.05),which shows that the two groups is comparable.Research methods1、Set up diabetes education team which includes first-class hospital diabetes specialist, diabetes nurses, and community general practitioners. The junior doctors and nurses are responsible for the systematic IGT education and professional guidance.2、The general practitioner is responsible for the daily management and registration of IGT patients, measuring the body weight, waist circumference, blood pressure and blood glucose for all the cases monthly, and telephone follow-up on a regular basis.3、Diabetes specialist doctors and nurses carry out the systematic diabetes education to IGT patients, including concept, harm, prevention and treatment knowledge, dietary guidance, sports guidance, health concept, psychological counseling and prevention of complications of diabetes and IGT, etc.4、Education group conducted a two-year systematic diabetes education, contents include:① Diabetes health education class:teaching systematic diabetes knowledge about prevention and control for people with IGT to make them be aware of the dangers of diabetes and diabetes is preventable and controllable, and increase their confidence in stress condition and the prevention and control of diseases.② The diet and exercise guidance:emphasizing on the importance of diet and exercise for the prevention and control of diabetes and help them to change their diet, control the total calories; encouraging to take part in sports and practice Baduanjin exercise, and insist for a long time. By diet and exercise guidance, help them form healthy way of life and maintain appropriate body weight. ③ the doctor-patient communication:doctors and IGT interaction as well as their personal experience and comments for the chronic disease self-management, the diabetes self-management theory (through the concept of recognition, goal setting, self-monitoring, self reinforcement and practice methods of nursing) the introduction of IGT phase control;④ giving out the manual and promotional materials of diabetes knowledge for them to study by themselves.5、Control group can obtain oral education about general knowledge of diabetes and pre-diabetes from television, Internet and other related publicity materials, without special diabetes education.6、The two groups were followed up every 3 months, and FPG, OGTT2hPG and GHbA1c were measured.Results and analysisComparison between the health education group and the control group. Health education group includes 16 males and 34 females; the average age was 58.25±6.30 years. The control group includes 12 males and 24 females; the average age was 59.24±6.34 years. There is no significant difference between the age, sex and body mass index of the two groups (P>0.05), showed that the two groups were comparable.2、Comparison of the index changes in glucose metabolism in the two groups before the intervention and after the follow-up of 2 years. There is no statistically significant difference (P>0.05) between the pre-intervention FPG, OGTT 2hPG and indicators GHbA1c in the two groups. Follow-up of 2 years after the intervention significantly reduced OGTT 2hPG and GHbAlc parameters in the health education group (P<0.01), but the change of FPG is not significantly different (P>0.05); control group intervention and follow-up of 2 years after the FPG and OGTT2hPG significantly increased (P<0.01), while the change of GHbA1c is not significantly different (P>0.05). Health education intervention and follow-up of 2 years after the FPG OGTT2hPG extent were significantly obvious than the control group (P<0.01), while the health education group and the control group GHbA1c indicators reduce the degree of difference was not statistically significant (P>0.05).3、IGT outcome of the two groups. Normal glucose tolerance rate in the health education intervention group after the 2 years follow-up for was 30.0%, was significantly higher than that of the control group (8.3%) (P<0.01); diabetes conversion rate of health education group was 4.0%, lower than the 22.2% in the control group (P<0.05).Conclusions and suggestionsBy observing the systematic health education group and the control group, regular monitoring of FPG, OGTT 2hPG and GHbAlc indicators, our group finds that normal glucose conversion rate of health education group was significantly higher (P<0.01), diabetes conversion rate was significantly lower than the control group (P<0.05), whereas no significant difference before and after the intervention for the GHbAlc (P>0.05). Studies have shown that health education system has important significance for outcome of IGT.System health education is one of the most important method for diabetes prevention, but is rarely referred to in clinical practice, especially for those who have IGT. In the general population, witting rate of the IGT concept and its harmfulness are low, carrying out health education can make people understand the basic knowledge of diabetes and the IGT, and encourage them to take a healthy diet and have exercise to lose weight, thus improving the body mass index and insulin resistance, improving the protection of islet cells secrete function, and to slow or reverse from the speed of IGT develop to type 2 diabetes outcome, and avoiding unnecessary expenses of drugs and drug side effect. This study created a education mode with diabetes specialist, diabetes specialist nurses from the top three hospitals and communities as the main body of the diabetes team, the general practitioner is responsible for the daily management, specialist doctors and nurses are responsible for the education system and professional instruction and formed the diabetes education program, which is suitable for the community to carry out, and easy to promote, will provide a scientific basis for prevention and control of diabetes especially the IGT for the community, and will bring the corresponding social benefits. |
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