Effects of Health Coaching Combined with Wearable Devices on Glucose and Lipid Metabolism and Self-management Behavior in Patients with Type 2 Diabetes Mellitus
摘要: 背景 2型糖尿病（T2DM）已成为当前全球面临的公共卫生负担，随着互联网和数字技术的迅猛发展，智慧服务模式在T2DM患者管理中发挥重要作用。目的 探讨可穿戴设备联合健康教练技术在T2DM患者中的应用效果。方法 选取2020年6月—2021年6月在南昌大学第二附属医院住院的315例T2DM患者为研究对象，依据随机数字表法将患者分为对照组、干预A组和干预B组，对照组实施基于毛细血管血糖监测的常规管理措施；干预A组采用可穿戴设备进行常规管理；干预B组采用可穿戴设备联合健康教练技术进行管理。比较三组干预前及干预后3、6、9、12个月时的血糖、血脂控制状况及自我管理行为上的差异。结果 研究实施期间共失访15例，最终纳入分析的研究对象共300例，三组各100例。三组在餐后2小时血糖（2 hPG）、糖化血红蛋白（HbA1c）、低血糖发生次数、高密度脂蛋白胆固醇（HDL-C）、2型糖尿病自我管理行为（2-DSCS）和糖尿病患者自我管理行为（SDSCA）评分上干预方法与时间存在交互作用（P<0.05）。干预方法对低血糖发生例数、总胆固醇（TC）、HDL-C、2-DSCS和SDSCA评分主效应显著（P<0.05）。除低血糖发生次数之外，时间在各项指标上的主效应显著（P<0.05）。各组干预后 3、6、9、12个月时的HbA1c、空腹血糖（FBG）、2 hPG、TC水平低于同组干预前，2-DSCS评分及SDSCA评分高于同组干预前（P<0.05）。干预3个月后：干预B组低血糖发生次数低于干预A组和对照组；干预B组HDL-C水平、SDSCA评分高于对照组（P<0.05）。干预6个月后：干预B组2 hPG、TC水平低于对照组；干预A组和干预B组的HDL-C水平、2-DSCS评分、SDSCA评分高于对照组；干预B组SDSCA评分高于干预A组（P<0.05）。干预9个月后：干预B组FBG、2 hPG、TC水平低于对照组；干预B组FBG、2 hPG水平低于干预A组；干预B组HDL-C水平、2-DSCS评分、SDSCA评分高于对照组；干预B组2-DSCS评分、SDSCA评分高于干预A组（P<0.05）。干预12个月后：干预B组FBG、2 hPG、HbA1c、TC、LDL-C水平低于对照组；干预B组FBG、2 hPG、HbA1c水平低于干预A组；干预B组的HDL-C水平、2-DSCS评分、SDSCA评分高于对照组和干预A组（P<0.05）。结论 可穿戴设备联合健康教练技术在改善T2DM患者糖脂综合控制状况、提高其自我管理能力具有短期及长期效果。
Abstract: Background Type 2 diabetes mellitus（T2DM） has become a public health burden facing the whole world，with the rapid development of Internet and digital technology，intelligent service model plays an important role in the management of patients with T2DM. Objective To explore the effectiveness of wearable devices combined with health coaching in patients with T2DM. Methods A total of 315 patients with T2DM who were hospitalized in the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were selected as the study subjects，and divided into the control group， the intervention A group and the intervention B group based on the method of randomized numerical table，the control group implemented the routine management measures based on capillary blood glucose monitoring，the intervention A group adopted the wearable devices for routine management，the intervention B group was managed by wearable devices combined with health coaching. The differences in glycemic and lipid control status and self-management behaviors among the three groups before and 3，6，9 and 12 months after intervention were compared. Results A total of 15 lost visits were made during the implementation of the study，and 300 study subjects were finally included in the analysis，with 100 in each of the three groups. There was an interaction between intervention method and time in the three groups on 2-hour postprandial blood glucose（2 hPG），glycated hemoglobin （HbA1c），number of hypoglycemic episodes，low-density lipoprotein cholesterol （LDL-C），self-management behaviors of diabetes mellitus （2-DSCS），and self-management behaviors of diabetic patients （SDSCA） scores（P<0.05）. There was a significant main effect of intervention method on the number of hypoglycemic episodes，total cholesterol（TC）， high-density lipoprotein cholesterol（HDL-C），2-DSCS and DSCS scores（P<0.05）. The main effect of time was significant on all indicators except the number of hypoglycemic episodes（P<0.05）. The levels of HbA1c，FBG，2 hPG，TC at 3，6， 9，and 12 months after the intervention in each group were lower than those before the intervention in the same group，and the level of 2-DSCS and DSCS scores of T2DM patients were higher than those before the intervention in the same group. After 3 months of intervention， the number of hypoglycemic episodes were lower in the intervention B group than in the intervention A group and control group（P<0.05）；after 6 months of intervention，the 2hPG level and the TC level in the intervention B group were lower than those in the control group （P<0.05），HDL-C level，2-DSCS score，SDSCA score in the intervention A and intervention B groups were higher than the control group（P<0.05），SDSCA score in the intervention B group was higher than the intervention A group（P<0.05）；after 9 months of intervention，FBG level，2hPG level，and TC level in the intervention B group were lower than those in the control group（P<0.05），FBG level and 2hPG level in intervention B group were lower than those in intervention A group，HDL-C level，2-DSCS score，and SDSCA score in the intervention B group were higher than those in the control group（P<0.05），2-DSCS score and SDSCA score in the intervention B group were higher than those of the intervention A group（P<0.05）；after 12 months of intervention，FBG level，2hPG level，HbA1c level，TC level，LDL-C level in the intervention B group were lower than those in the control group（P<0.05），FBG level，2hPG level，HbA1c level in the intervention B group were lower than those in the intervention A group，HDL-C level，2-DSCS score，and SDSCA score in the intervention B group were higher than those in the control and intervention groups（P<0.05）. Conclusion Wearable devices combined with health coaching has short-term and long-term effects in improving the comprehensive control of glucose and lipids，as well as improving self-management ability of them in patients with T2DM.