Type 1 diabetes mellitus: can coaching improve health outcomes?

ABSTRACT Objective: To evaluate the introduction of coaching in the interdisciplinary care of individuals with type 1 diabetes mellitus in the public health care system. Subjects and methods: Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES). Results HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements. Conclusion: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals.

摘要
研究目的：评估在公共卫生保健系统中，将辅导干预引入1型糖尿病（type 1 diabetes mellitus）患者多学科照护的实践效果。
研究对象与方法：招募10名定期在公共卫生保健机构就诊、糖化血红蛋白（glycated hemoglobin, HbA1c）水平高于7.5%的受试者参与8次辅导课程。本研究评估受试者的疾病自我管理能力与个人行为表现，分别在项目启动之初、干预后两个时间点开展评估，检测内容包括生化与人体测量学指标，以及自我血糖监测（self-monitoring of blood glucose, SMBG）频率。各评估节点均采用标准化问卷量表进行测评：情绪负担采用B-PAID量表、药物依从性采用Morisky依从性量表、自我效能感采用IMDSES量表。
研究结果：研究启动时，受试者的HbA1c中位数为8.0%（范围7.6%~10.3%）；干预启动3个月后，该指标显著降低（7.78% [6.5%~10%]，p=0.028）；6个月时未出现显著升高（8.3% [7.13%~9.27%]，p=0.386）。自我血糖监测频率从研究初始至全程均得到显著改善，每周血糖检测次数的中位数从基线的16.5次（范围0~42次）分别提升至3个月时的29.0次（7~42次）、6个月时的27.5次（10~48次），差异具有统计学意义（p=0.047）。三次评估节点的人体测量学参数与各量表得分均未出现显著差异。
研究结论：以患者价值观与目标感为核心的辅导干预，可在传统糖尿病教育方案的基础上提供额外获益，有望作为辅助手段帮助1型糖尿病患者达成治疗目标。