A Randomized Controlled Study Of The Effects Of Comprehensive Core Intervention Based On Self-management Support On Blood Glucose Control In Community-based Elderly Patients With Type 2 Diabetes

Objective To study the effects and influencing factors of the comprehensive core intervention based on self-management support on blood sugar control of in elderly community-based patients with type 2 diabetes,so as to provide a scientific reference for the selection and optimization of comprehensive prevention and treatment strategies of blood glucose control and health management for elderly patients with T2 DM in community,saving health resources,improving the self-management abilities of patients and the effect of blood glucose control.Methods 1 A network meta-analysis of the effects of different interventions on blood glucose in patients with type 2 diabetes We searched randomized controlled trials on effects of different single intervention modes on blood glucose of patients with type 2 diabetes from January 1,2010 to December 31,2019,including exercise,diet,self-monitoring of blood glucose,psychology,counseling and communication,health education,lifestyle,and usual care.The databases are: Cochrane Trails,Pub Med,Embase and other 6 databases.The MD and 95% CI of Hb A1 c,fasting blood glucose,and postprandial blood glucose before and after intervention were pooled as outcome effect indicators.94,43,and 33 studies were included,respectively,and publication bias and small-sample effects were evaluated by calibrated funnel plots.By calculating the surface area under the accumulation ranking curve,the therapeutic effect ranking of each intervention method was obtained.2 A randomized controlled study of the effect of comprehensive core interventions based on self-management support on blood glucose control in community-based elderly patients with type 2 diabetes A total of 150 elderly patients with type 2 diabetes aged 65 and above who were registered in a community health service center in Fuzhou were recruited to participate in the study and randomly assigned to the intervention group or control group using computer random number table 1:1.The intervention group received 12 months of a comprehensive core intervention based on self-management support.Integrated core intervention was developed based on previous studies,including 8 dimensions of low-carb diet,walking exercise,self-monitoring of blood sugar,etc.Self-management support was provided to the intervention group through on-site self-management education lectures,on-site consultation and guidance,distribution of core knowledge education materials,and telephone follow-up support.Self-management guidance was provided twice a month.The control group received routine community care and education,and blood glucose was recorded through routine follow-up.Blood glucose levels and self-management scores before and after intervention were compared by Mann-Whitney U test.Wilcoxon signed rank test was used to compare blood glucose values and self-management scores in each group before and after intervention.Chi-square test was used to compare blood glucose control rates before and after intervention to study the efficacy of intervention.3 Analysis on the influencing factors of the intervention effect of elderly patients with type 2 diabetes in the community Based on the above-mentioned randomized controlled trials,the blood sugar control status,sociodemographic characteristics,disease-related characteristics,and self-management ability were compared before and after the intervention.The effect of blood glucose control was used as the dependent variable,and the sociodemographic characteristics and disease-related characteristics of the patient were used as independent variables.Chi-square test and single-factor Logistic regression were performed.Finally,a multi-factor Logistic regression model was established to explore the factors affecting the effect of blood glucose control.Results 1 A network meta-analysis of the effects of different interventions on blood glucose in patients with type 2 diabetes(1)Taking glycosylated hemoglobin as an indicator and including 94 literatures,the SUCRA score of psychological intervention is 97.7%,which is the most likely to be the best intervention.(2)Taking fasting blood glucose as an indicator,including 43 literatures,the SUCRA score of dietary intervention is 94.3%,which is the most likely to be the best intervention.(3)Taking postprandial blood glucose as an indicator,33 literatures were included,and the SUCRA score of lifestyle intervention was 96.6%,which is the most likely to be the best intervention.2 A randomized controlled study of the effect of comprehensive core interventions based on self-management support on blood glucose control in community-based elderly patients with type 2 diabetes(1)Fasting blood glucose:(1)Comparison within the group: After the intervention,the FBG level of the intervention group was lower than the baseline,and the difference was statistically significant(P<0.05),while the FBG level of the control group was not statistically significant(P>0.05).(2)Comparison between groups: After the intervention,the difference in FBG levels between the two groups was statistically significant(P<0.05).(2)Blood glucose control rate: After the intervention,the blood glucose control rate of the intervention group was 66.18%,which was an increase of 16.18% compared to the baseline;the blood glucose control rate of the control group was 28.81%,which was a decrease of 16.95% compared to the baseline.The difference in the end-point blood glucose control rate between the two groups was statistically significant(P<0.05).(3)Blood glucose fluctuations: the overall follow-up blood glucose variation coefficient of the intervention group CV% = 16.16%;the control group overall follow-up blood glucose variation coefficient CV% = 16.41%.Repeated measurement analysis of variance showed that there was no statistically significant difference in follow-up blood glucose values between the two groups(P>0.05),while the difference in follow-up blood glucose values over time was statistically significant(P<0.05),and there was also a difference between groups and time Interactive effect(P<0.05).Group individual effect test indicated that there was a statistically significant difference in follow-up blood glucose between the two groups at multiple follow-up time points(P<0.05);time individual effect test indicated that the follow-up blood glucose of the intervention group was significantly different from baseline(P<0.05)while the difference in the control group was not statistically significant(P>0.05).3 Analysis on the influencing factors of the intervention effect of elderly patients with type 2 diabetes in the community(1)Multivariate logistic regression results showed that receiving comprehensive core intervention based on SMS,lower age,and good baseline blood glucose control are protective factors that affect the blood glucose control effect of subjects in the comprehensive core intervention based on SMS(P<0.05).(2)Changes in self-management:(1)Comparison within the group: After the intervention,the intervention group had higher scores in the dimensions of medication,communication,work rest,mood,and self-efficacy compared with the baseline,and the difference was statistically significant(P<0.05).Compared with the baseline,the scores of the control group in the dimensions of emotion and self-efficacy increased,and the difference was statistically significant(P<0.05).(2)Comparison between groups: After the intervention,compared with the control group,the intervention group had higher scores in the dimensions of diet,medication,communication,work rest,mood and self-efficacy,and the difference was statistically significant(P<0.05).Conclusion(1)Psychological intervention,diet intervention and lifestyle intervention have the best intervention effects in reducing glycosylated hemoglobin,fasting blood glucose and postprandial blood glucose respectively in type 2 diabetic patients.(2)Comprehensive core intervention based on self-management support has a positive effect on reducing fasting blood glucose levels,improving blood glucose control rate,and stabilizing blood glucose fluctuations in elderly type 2 diabetic patients.(3)Acceptance of DSMS-based comprehensive core intervention,lower age,and good baseline blood glucose control are protective factors that affect the blood glucose control effect of subjects in DSMS-based comprehensive core intervention.