Study On Applying Implicit Learning Theory In Injecting Technology Learning For Elderly Type 2 Diabetic Patients

Part 1 Survey of Insulin Pen Injection Technology and Its Effect on Blood Glucose Controlin Type 2 Diabetic PatientsObjective: To investigate the status of type 2 diabetic patients of their currently insulin pen injection technology and to explore its impact on their blood glucose control.Methods: A cross section survey was conducted by general information questionnaire and Insulin-pen application Questionnaire. From April to June 2012, 220 insulin-injecting type 2 diabetic patients from 12 hospitals and 2 communities in Suzhou were investigated regarding to their injection practices and the levels of blood glucose. Insulin-pen application Questionnaire was consisted of three factors, they are Precise Injection(Factor-1), Frequency of the complications related to Injection(Factor-2) and the Compliance of monitoring blood glucose(Factor-3). Total scores of three above factors would be called as Total score of injection for short below.Results: Overall, the elderly accounts for 56.8%. Total score of injection was 77.2±10.6. Factor-1 scored 85.7±13.0, Factor-2 scored 75.8±14.6, and Factor-3 scored 61.9±18.5. Level of fasting blood glucose(FBG) was significantly different between the patients with or without complications related to DM. In addition, Factor-1 and Factor-3 could significantly influence the level of FBG(P<0.05).Conclusion: The injection technology of insulin pen could impact the blood glucose control in type 2 diabetic patients. We should pay more attention on these factors.Part 2 Study on Applying Implicit Learning Theory in Injecting Technology Learningfor Elderly Type 2 Diabetic PatientsObjective: To explore the effect of applying implicit learning theory in injecting technology learning on elderly type 2 diabetic patients, and to study whether the program could improve blood glucose.Methods: A randomized controlled single-blind study was performed. According to the inclusion criteria, 84 cases were randomly assigned into control group(N=42) and intervention group(N=42). Control group received usual care, while intervention group received program applying implicit learning theory in injecting technology teaching(Implicit learning intervention). Implicit learning intervention consisted of three aspects.(1) Analogy learning makes patients a ready judgment to subcutaneous injection performance;(2) Observational learning intends to give patients perceptual knowledge about subcutaneous injection performance, and improvement in overall injection performance;(3) Meditation exercises help form correct image to subcutaneous injection performance;(4)Errorless learning help correct performance timely, make performance accuracy. Practicing repeat facilitate performance an autonomous stage. Interventions were finished during hospital stay. Baseline information was collected before discharge. Scheduled clinical follow-up or telephone visits for measurements was taken at 1, 3, 6 months(post intervention) and comparisons were made finally. Assessments contain injection technology; glycemic control; hypoglycemic events; insulin dose adjustment and insulin treatment satisfactory.Results:(1) Injection technology;① At 1, 3, 6 months(post intervention), total scores of Insulin-pen application Questionnaire in intervention group were higher than the ones in control group. The difference between them was statistically significant(P<0.05). At 1, 3, 6 months(post intervention), score of Precise Injection(Factor-1) in intervention group was higher than the control group. The difference between them was statistically significant(P<0.05) at 1,6 months. ② With-in comparison showed that intervention group had significant scores in total injection questionnaire and factor-3(P<0.017) while control group had no significant difference in all factors.(2) Glycemic control;①At 3, 6 months( post intervention), the level of FBG(Fasting blood glucose) and 2h PG(2h Postprandial glucose) in intervention group were lower than the ones in control group. The difference between them was statistically significant(P<0.05). ② With-in comparison showed that control group had a significantly higher level of FBG and 2h PG at 6 months compared with baseline(P<0.05), while in intervention group, there was no significant change. ③Result also suggesting that change of FBG was associated with group factors, while 2h PG was associated with time factors.(3) At 6 months, intervention group had significantly more cases that insulin dose as recommended was less than baseline(P<0.01). Hypoglycemic events have no significant difference between two groups.(4) Insulin treatment satisfactory;At 6 months, intervention group had significantly higher scores in subscales of Inconvenience of Regimen, Glycaemic Control, Device Delivery Satisfaction and total ITSQ(P<0.01).Conclusion: Implicit learning has a positive improvement on insulin pen injection technology for elderly T2 DM, which gradually improves their level of blood glucose, insulin dose, insulin treatment satisfactory.