Impacts Of Patients For Patient Safety Managment Model In Patients With Type 2 Diabetes Who Received "3C" Treatment

Objective Patients for Patient Safety(PPS)management model is a model to achieve the persistent healthy behaviors in patients and to encourage patients to participate in the management.Traditional diabetes health education is,to a larger extent,passive,has poor effects and is hard to meet the needs of today's medical care.Diabetes 3C therapy(Combined with Continuous glucose monitoring system,continuous subcutaneous insulin infusion and Carelink software)has been gradually extended to clinical work.It can not only improve the treatment effect,but may also provide avisual educational tool for communicating between care givers and patients.Therefore,the 3C therapy has the potential to help patients with type 2 diabetes mellitus(T2DM)to actively participate in health education.The aims of the study is to test the effect of PPS in T2 DM treated with the “3C”therapy on hyperglycemia control,and whether PPS can improve empowerment,diabetes knowledge and selfmanagement ability.Method We used a randomized controlled trial to address the issue.Glycated hemoglobin(Hba1c)after 6 months of intervention was used as the primary outcome measure.A sample size of 130 cases(65 in the intervention arm and 65 in the conventional care arm)was able to achieve 80% power if type I error was set at 0.05 and the Hb A1 c reduction was set at 1.00%.A simple randomization procedure was used to assign patients to receive the intervention or the conventional care.A total of 130 patients with T2DM(66 in the intervention arm and 64 in the conventional care arm)who met the inclusion criteria but did not have the exclusion criteria participated in the trial.Before the intervention,all the patients were asked to complete a questionnaire that contained Diabetes Self-Care Scale,Chinese Version for Diabetes Empowerment Scale-Short Form and Diabetes Knowledge Test Scale.Glycemic profile including Hb A1 c was documented at baseline,3 months and 6 months after discharge.All these scales were collected in a longitudinal way,at 1 month after discharge at their outpatient visit.All the data were analysed using Statistical Package for Social Science version 19.0(SPSS).T-test or nonparametric analysis where appropriate was used to compare the difference in continuous variables between two groups and Chi-square test or Fisher's exact test where appropriate was to compare categorical variables between two groups.Result A total of 65 patients in the intervention group and 60 patients in the conventional care group completed the trial.Demographic and metabolic variables were similar in the intervention group and the conventional care group.1.The intervention significantly reduced fasting peripheral blood glucose at discharge(7.13±1.13 vs.7.69±1.05,t=0.95,P=0.00),3 monthsafter the discharge(7.59±1.33 vs.8.14±1.25,t=2.37,P=0.02),6 months after discharge(7.79±1.32 vs.8.20±1.36,t=2.10,P=0.04).The intervention also significantly reduced 2-h plasma glucose at discharged(9.10±1.11 vs.9.85±1.29,t=3.49,P=0.00),3 months discharge(9.79±1.51 vs.10.55±1.49,t=2.83,P=0.01),6 months after discharge(9.95±1.61 vs.10.98±1.69,t=3.42,P=0.00).Consequently,Hba1 c in the intervention group was significantly lower than in the conventional care group at 3 months(7.42±0.89 vs.7.74±0.67,t=2.26,P=0.03),6 months(7.40±0.95 vs.7.84±1.02,t=2.45,P=0.02)after discharge from the hospital.The intervention group also had significantly higher scores of Mean Of Daily Differences(1.90±0.35 vs.1.44±0.25,P<0.01)and Mean Amplitude of Glycemic Excursions(1.36±0.27 vs.1.21 ±0.21,P<0.01)than the conventional care group.2.The intervention group had better diabetes knowledge(19.35±1.75 vs.13.20±2.90,t=4.84,P<0.05).3.The intervention also led to an increase in the knowledge regarding physical activity,diet,medications,self monitoring of blood glucose and other self-managementConclusion The PPS management mode in T2 DM treated with the “3C”therapy significantly improved hyperglycemic control and the effect persisted up to 6 months after discharge,with improved empowerment,and knowledge in diebetes and self-management.