| ObjectiveTo evaluate clinical effectiveness of Tai Chi,one of rehabilitation technics in TCM,on senile type 2 diabetes mellitus（DM）,construct a TCM-featured management platform for chronic diseases,which is characterized by“Internet plus TCM rehabilitation”and explore combined application of traditional Chinese rehabilitation technique and Internet technics in chronic disease management of senile type 2 DM,so as to provide TCM rehabilitation and health management projects with scientific proof for senile patients with chronic diseases represented by senile type 2 DM suffers.Methods1.A completely randomized clinical research method was implemented in the trial.108 eligible senile patients with type 2 DM were randomly assigned to an experimental group and a control group.Subjects in experimental group were required to practice Tai Chi for one hour every other day,36 sessions in 3 months.While subjects in control group were asked for one-hour regular walk every other day,also36 sessions in total.Medication and dietary habits in both groups stayed as usual.All subjects were received the relevant examination in accordance with the requirements of the test before the intervention,during the intervention,after the intervention,and during six-week and twelve-week follow-up.Evaluation indicators in the trial included clinical symptom alleviation,comparison of total DM symptoms integrally before and after intervention within each group;objective evaluation indicators contained Fasting Blood Glucose（FBG）and Glycosylated Hemoglobin（HbA1c）before and after intervention;Diabetes Specific Quality of Life scale（DSQL）、Self-Efficacy for Managing Chronic Disease 6-Item Scale（SES6G）and Geriatric Depression Scale（GDS）were filled in at following time-points,before intervention,after intervention,and the 6th and 12th week after intervention in follow-up period.2.The test was divided into two sections.The first section is similar with clinical observation method of disease surveillance,8 senile type 2 DM suffers from experimental group in preliminary clinical studies was adopted who accorded with the requirements.With the help of the mobile phone smart server and the wearable devices,subjects’daily morning FBG were monitored at 7 am in 30 days continuously.The second section is the research on the construction of remote management platform,which is“Internet plus TCM rehabilitation”,managing senile chronic disease represented by senile diabetes.By exploring the construction of a TCM-rehabilitation-featured,intellectualized and networked“Internet plus TCM rehabilitation”management platform for geriatric chronic diseases represented by senile type 2 DM,it helped better promotion and application of Chinese traditional rehabilitation techniques represented by Tai Chi in health service for geriatric patients with chronic diseases,so as to provide instant,active and effective health management for them,thus realizing the goal of slowing process of chronic diseases,preventing or reducing complications,improving life quality and providing further technical support for easing the heavy burden of national medical health resources caused by aging population in society.Results1.The clinical effective evaluation of Tai Chi on senile type 2 DM（1）The baselines of subjects in both groups were comparable（P>0.05）.（2）Total integral of T2DM symptoms showed that there were statistical differences（P<0.01）in clinical symptoms alleviation of both groups;besides,compared with control group,subjects in experimental group manifested better improvement in symptom alleviation with statistical significance（P<0.01）.Repeated measures analysis demonstrated that the difference of symptoms integral between experimental group and control group was of significant statistical differences（F=10.34,P<0.01）;The variation trend over time of clinical symptom integral was statistically significant（F=141.82,P=0.000）.The interaction effect between groups and time was statistically significant（F=43.37,P=0.000）,for groups difference was different from time.The changes of mean value in both groups showed a decline trend of symptom integral in experimental group after intervention,which indicated symptom improvement and a relatively stable state in later time-points.Subjects in control group suggested symptom improvement after intervention,but an increasing trend along with time.（3）Laboratory tests showed:（1）FBG value:there was no statistical differences between two groups after intervention（P>0.05）.The difference before and after intervention in experimental group was statistically significant（p<0.01）,but no statistical significance in control group（P>0.05）.Repeated measures analysis showed no statistical differences between two groups（F=0.073,P=0.787）.The variation trend over time of FBG value was statistically significant（F=5.074,P=0.000）.The interaction effect between groups and time was statistically significant（F=5.718,P=0.005）,indicating that grouping difference was different from time.By observing variation of mean value of two groups,It could be seen that the FBG value in both groups was declined after intervention and showed a gradually increasing trend at following time-points.（2）HbA1c value:The baseline of HbA1c value in two groups was in discord,therefore it was not appropriate to evaluate the symptom difference in two groups.As for HbA1c value within each group,FAS in control group showed statistical difference（p<0.05）while PP showed no statistical difference.It could not conclude that difference of Hb A1c value in control group before and after intervention was statistically significant because of disagreement in FAS and PP.The difference of HbA1c value in experimental group before and after intervention showed no statistical differences（P>0.05）.（4）Scale results showed that:（1）Diabetes Specific Quality of Life scale（DSQL）:there was statistical difference of DSQL score between two groups after intervention（p<0.05）.Difference of DSQL score in experimental group was statistically significant（p<0.01）before and after intervention,while there was also statistical differences in control group（p<0.01）.（2）Self-Efficacy for Managing Chronic Disease 6-Item Scale（SES6G）:there was statistical difference of SES6G score between two groups after intervention（p<0.01）.Difference of SES6G score in experimental group was statistically significant（p<0.01）before and after intervention,while there was no statistical differences in control group.（3）Geriatric Depression Scale（GDS）:there was statistical significance of GDS score between two groups after intervention（p<0.01）.Difference of GDS score in experiment group was statistically significant（p<0.01）before and after intervention,so was in control group（p<0.01）.2.The establishment of“Internet plus TCM rehabilitation”platform based on geriatric DM management.（1）The theory construction of"Internet plus TCM rehabilitation"management platformThrough the combination of chronic disease management platform and mobile intelligent devices,a new medical model-"Internet plus"was set up,which was real-time,efficient and convenient.The mode,together with"five carriages”of senile diabetes management and Tai Chi,one of TCM rehabilitation techniques,was integrated into the"Internet plus TCM rehabilitation"management platform for chronic diseases,which contains six functions,such as,user registration,file management of chronic disease,diabetes management,health assessment,TCM rehabilitation and follow-up.With the mobile phone intelligent health self-testing platform,it got involved five aspects,such as,diabetes education,diet management,exercise management,drug management and family society.It would help establish personalized rehabilitation exercise management and promote traditional Chinese medicine rehabilitation technology faster.The ultimate goal was to make simple and effective TCM rehabilitation exercise accepted by senile patients with chronic diseases,so as to ease the pressure of medical and health resources caused by aging population and progressively increasing number of patients with chronic diseases,to improve their health status and quality of life.（2）The results of the use of health self-inspection platform showed that:The average age of about 65 years of senile type 2 diabetes patients need to go through at least 3 times to fully grasp the use of the whole system.During the 30 days of continuous monitoring,the data missing rate was in the range of 11.67%.（3）The result of the effect of FBG value on the change of time showed that:according to correlation coefficient analysis results,numbers 1,2,5,7 showed a negative correlation,the correlation coefficient were-0.504,-0.503,-0.366 and-0.156,and with the extension of time,the FBG value decreases gradually;Numbers 3,4,6,8showed positive correlation,correlation coefficient were respectively,0.114,0.283,and 0.062,and with the extension of time,the FBG value increases gradually.Statistically significant correlation coefficients were numbered 1,2,5and 6respectively（p<0.05或p<0.01）.Thus it can be seen that the observation time of number 1,number 2,number 5 can affect the patients’FBG value,the value of FBG decreased with the prolongation of time;FBG values of number 6 increased with time.Further simple linear regression analysis could show that:time to determine the FBG value of the R2 in accordance with the number of orders were 0.265,0.253,0.096,0.166,0.083,0.012,0.017,The 26.5%of total variation of the FBG value of number 1was related to the time,and the 25.3%of total variation of the FBG value of number2was related to the time,and the 9.6%of total variation of the FBG value of number 3was related to the time,and the 16.6%of total variation of the FBG value of number 4was related to the time,and the 8.3%of total variation of the FBG value of number 5was related to the time,and the 1.2%of total variation of the FBG value of number 6was related to the time,and the 0.5%of total variation of the FBG value of number 7was related to the time,and the 1.7%of total variation of the FBG value of number 1was related to the time.Conclusions:1.The clinical curative effect of Tai Chi on senile patients with type 2 diabetes is better than that of routine walking.2.Tai Chi can improve the senile patients discomfort symptoms,help control the senile patients with type 2 diabetes fasting blood glucose in the standard level,improve the patients’ability of self-management,adjust the patient’s mood,to achieve the improvement of survival quality as a whole.Therefore,Tai Chi is suitable for elderly patients with type 2 diabetes.3.The platform could achieve comprehensive,timely and accurate disease management to the elderly patients with type 2 diabetes,and would promote Traditional Chinese medicine sports rehabilitation technology like Tai Chi in senile chronic diseases like senile Type 2 DM.It provides a new model for the rehabilitation of chronic diseases in the elderly,and provides a new way to alleviate the burden of national health resources and the prevention and control of chronic diseases.4.Self-testing platform can achieve continuous monitoring on the glycemic index of healthy elderly patients with type 2 diabetes mellitus,and the data is real,timely and efficient,which could provide reference parameters for the development of individualized exercise program for elderly patients. |
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