| Objectives:With the development of the economy, the improvement of the living standard, the changing of lifestyle and the increasing of aging population, more and more people develop type 2 diabetes. Recently, China is troubled with the large number of diabetics and the bottleneck of control issues. Although the local governments attach much more importance on the application of community treatment and the standardized management of family in recent years, it still cannot meet the needs of the surging diabetics. With the combined impact of genetics and environment and the chronic of the disease, diabetics suffer a lot of psychological problems and depression is one of the most common one. Meanwhile, the interwoven physical and mental problems have a lot of negative influence on the lives of the patients, for example, sleep problems are widespread in diabetics with depression. And because of the pathological and physiological changes and psychological problems caused by the diabetes and the unhealthy lifestyles, the control of diabetes is meeting great challenges. Facing with the growing number of diabetics and the increasing complexity of the patients' condition, the exploration of a more effective prevention technology becomes very important in enhancing the management of diabetes. As the concept of disease treatment is updating with the developing of the modern technologies, it is worth mentioning that for the diabetes, the health education and the support of self-management activity is much more important. Recently, professional in the filed of the m-health, peer education and the music therapy on chronic disease self-management support aspects of the researches are on the rise. Peer education can help the diabetics implement self-management and increase self-efficacy by providing them social and emotional support continuously while m-health offers medical service and information with the help mobile communication technologies and in terms of the management of diabetes, m-health helps the community doctors grasp the blood sugar level of the patients in order to lead the patients adjust their lifestyle, help the patients improve glucose control, optimize hypoglycemic treatment and realize individualized diabetes management. And for the patients with sleep disorders, as an important non-drug treatment, music therapy has been widely adopted. It betters the patients' sleep quality by activating cerebral limbic system in order to give rise to the corresponding psychological and mental reaction.For the type 2 diabetics, our research compared the changes of patients' evaluation index after acquiring the peer education and the regular education for six months. And for the type 2 diabetics with sleep and depression disorders, our research studies the effect of peer education combined with music therapy and m-health to their health behavior and clinical indicators. Finally, we evaluated the feasibility and the necessity of multiple interventions in the management of diabetes in community. Methods:In the first stage of the research, according to the inclusion and exclusion criteria, we investigated 193 diabetic patients in 2nd, Ruijin Road, Community Health Service Center in Huangpu section in Shanghai. All type 2 diabetic patients were randomly divided into two groups, there are 96 patients in peer support group, while 97 individuals in control group. The peer support group divided into six small groups which were in charge of two well-trained peer volunteers. Both groups will receive regular diabetes medication and group education courses including DSME(Diabetes Self-management Education), psychological support, improvement in sleep. We assessed the changes of patients FPG and Hb A1 c, diabetes education and self-management behavior of two groups after 6 months.In the second stage of the research, 45 patients with T2 DM who also have sleep disorders and mild depression in the community will be recruited and stochastically divided into the multiple interventions group(n=22) and the control group(n=23). The multiple interventions group will be under the guidance of two well-trained peer supporters to carry out group activities. Each supporter will be in charge of 8 patients.Starting with peer support therapy in the first three months, the intervention group will then take Yoga music therapy before bed for another three months and be given support and guidance by the peer supporters. Compare the baselines and variations of two group's sleep, depression, blood sugar and related biochemical indicators, and self-management and other aspects at the third month and sixth month. The final evaluation will show the effect and related influencing factors of peer support and yoga music therapy in helping Type 2 diabetic patients who have sleep disorders and mild depression to improve their sleep quality. Results:In the first stage of research, the study shows that the two groups at baseline has no significant difference in the basic data. Compared with the control group patients, the patients' Hb A1 c in peer support group has significant improvement after 6 month(7.15±1.04 vs 7.53±1.63, P<0.05), besides, the peer support group individuals achieved significant improvement in diabetic self-management behaviors and self-efficacy after 6 months, and the improvement in self-efficacy of peer support group was significant different compared with the control group(109.20±13.88 vs 102.09±14.67, P<0.05).In the second stage of research, after 3 months, no statistical difference of PHQ-9 depression score was found between the multiple interventions group and the control group. But compared with the baseline, there is statistical difference in the multiple interventions group after 3 months(4.43±4.09 vs 8.09±2.45, P<0.05). After 6 months, combined with music therapy, the PHQ-9 depression scores in the multiple interventions group patients were improved more(2.55±1.67 vs 5.95±4.02, P<0.05). we used the PSQI scale to evaluate the effect of the intervention, after 3 months, compared with the baseline, there is statistical difference in the multiple interventions group(9.62±4.04 vs 12.36±4.00, P<0.05). After 6 months, the PSQI scores in the multiple interventions group patients were improved more(8.81±4.43 vs 12.36±4.00, P<0.05). When used the sleep parameter to evaluate the sleep quality, comparing with the baseline, statistical difference of TST was found after 6 months(460.5±81.79 vs 384.62±89.32, P<0.05). Conclusions:On the basic of routine clinical treatment in community, multiple interventions(the m-health, peer education and the music therapy) can further improve the effect of type 2 diabetic clinical treatment, self-management behaviors and self-efficacy. We should promote the application of multiple interventions in community, which can further improve the control effect of chronic diseases and achieve better clinical treatment and health economic effect. |
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