Effects Of Education And Management Program Of "Hospital-Family" Linkage On Diabetes Patients With Insulin Pump Therapy

Objective:To explore the effect of education and management program of “hospital-family” linkage in diabetes patients with insulin pump therapy.Methods: 40 patients with diabetes using the insulin pump therapy from 2013 March to 2015 September in Department of Endocrinology and Pediatric in Shandong Provincial Hospital who met the inclusion criteria of this study were enrolled,and received the hospital-family education and management program,and then the changes of fasting blood glucose,glycosylated hemoglobin(Hb Alc)level,the use knowledge and skills of insulin pumps,the condition of pump adverse events,diabetes self-management ability were measured respectively at 6 months after discharged.Results:(1)39 patients were enrolled in the study,and at the time of admission,the mean level of fasting blood glucose was 9.71 ± 5.13mmol/L,and the mean glycated hemoglobin level was 9.36 ± 2.49%. The main reason for hospitalization: 19 cases were poor glycemic control(48.72%), acute complications of diabetes were7(17.95%) cases, chronic complications of diabetes were5(12.82%) cases,the other were 8(20.51%) cases.(2)At 6 months after discharged,the fasting blood glucose(6.20±1.29mmol/L),glycosylated hemoglobin(Hb Alc) level(6.76±0.96%) were significantly improved compared with before(9.71±5.13mmol/L, 9.36±2.49%)(P<0.01).(3)The project "the insulin type and use method of insulin pump therapy","the content of insulin pump daily self-examination ""identification and treatment of common insulin pump alarm","correct approach to identify and treat hypoglycemia reactions ","properly protect the insulin pump"and"the notes when business trip or travel"were different compared with the level of admission time,the rest showed no significant difference(P>0.05).(4)Compare with discharged,at 6 months after discharged,the occurrence of hypoglycemia and hyperglycemia were significantly reduced(P<0.01); the occurrence of injection site induration or skin infections,and infusion barrier were reduced,but there was no statistics difference compared with at the admission time(P>0.05).(5)At 6 months after discharged,the patient self-management level was significantly higher than the level of at admission(P<0.01).Conclusions:(1)There are phenomenons of abnormal blood glucose levels and occurrence of adverse events associated with pump,and even diabetic ketoacidosis in diabetes who outside the hospital with insulin pump therapy,For this reason patients may be hospitalized again.Therefore, strengthening the management and education for these patients is imperative.(2)The management program educated and managed patients and their families during hospitalization,and via the telephone and We Chat and family follow-up and outpatient health education extending the health education from hospital to homes. Patients can communicate with health care workers anytime and anywhere to improve insulin pump use knowledge and skills,reduce the occurrence of hyperglycemia and hypoglycemia and pump-related adverse events.(3)The management program regularly remind patients to follow doctor’s orders,check the implementation of the patient,and feedback to the health care provider.Families receiving health education at the same time can assist health managers to help patients establish the correct life habits,in order to maintain higher level of self-management and better glycemic control.