자가혈당 측정결과기반 당뇨교육프로그램이 제2형 당뇨병환자의 혈당조절에 미치는 효과 = Effect of Self-Monitoring of Blood Glucose Based Diabetes Self-Management Education on Glycemic Control in Type 2 Diabetes

다국어 초록 (Multilingual Abstract)

Purpose: The aim of the study was to evaluate the effect of self-monitoring of blood glucose (SMBG)-based Diabetes Self-Management Education (DSME) on glycemic control in type 2 diabetes.
Methods: This study was designed to compare changes in glycemic control over 12months in SMBG-based DSME group (n=65) versus control group (n=65). Data were obtained from medical records type 2 diabetic patients treated with oral antidiabetic agents and above HbA1c 7.0% from June 2006 to August 2008. All participants completed DSME defined as informational intervention of lifestyle habits and reinforcement of educational Monthly News letter delivered by the diabetes nurse educator. SMBG-based DSME group requested to measure blood glucose 7 times a day for a week and to record their diary and received counseling with a focus on diet and lifestyle during the education. Assessments were conducted baseline, 3, 6 and 12 months. HbA1c was used as an index of glycemic control.
Results: 12 months later, the level of HbA1c was reduced by 1.28±1.68% in experimental group and 0.49±1.05% in the control group. We found a significant effect of Time* Group interaction (p=.013).
Conclusion:SMBG-based DSME for patients with type 2 diabetes with oral antidiabetic agents was effective in improving glycemic control and maintaining long-term glycemic control.

국문 초록 (Abstract)

본 연구는 경구혈당강하제를 복용하는 제2형 당뇨병 환자를 대상으로 자가혈당 측정결과기반 당뇨교육프로그램이 혈당조절에 미치는 효과를 알아보고자 시도되었으며, 연구결과에따른 결론은 다음과 같다.
자가혈당 측정결과기반 당뇨교육프로그램은 두 군 간에는유의한 차이가 없었지만 당화혈색소 변화는 시간이 경과함에따라 유의한 차이가 있는 것으로 나타났으며(p=.013), 실험군의 당화혈색소가 대조군에 비해 더 많이 감소되었다. 이러한점을 고려할 때, 일주일간의 집중적인 자가혈당 측정을 기반으로 지속적인 추구관리를 포함한 당뇨교육 프로그램은 향후효과적인 교육모델로 활용될 수 있을 것이라 사료된다.
이상의 연구결과를 토대로 다음과 같은 제언을 하고자 한다.
첫째, 제 2형 당뇨병환자들에게 자가혈당 측정결과를 기반으로 하는 당뇨교육 프로그램을 임상현장에서 당뇨관리시스템으로 적용해 볼 것을 제언한다. 둘째, 본 연구에서 적용된 중재방법 중 일부인 목표설정-추구관리 프로그램이 혈당조절에유의한 영향을 주는지를 확인해 보는 효과검증 연구를 제언한다.

참고문헌 (Reference)

1 박미숙, "혈당검사를 위한 진공자동채혈기법사용시 채혈부위와 바늘침투깊이에 따른 통증과 채혈량 분석" 한국간호교육학회 12 (12): 265-271, 2006

2 이윤욱, "제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과" 대한내분비학회 18 (18): 63-72, 2003

3 박석원, "전국표본조사에 의한 우리나라 당뇨병 관리실태: 건강보험자료 분석결과" 대한당뇨병학회 31 (31): 362-367, 2007

4 하정미, "일 병원 제2형 당뇨병환자의 자가혈당검사 수행 및 활용 실태" 한국간호교육학회 16 (16): 330-338, 2010

5 이영란, "당뇨입원교육프로그램이 제2형 당뇨병 환자의 지식, 자기효능감, 자가관리 및 당 조절에 미치는 효과" 한국간호교육학회 14 (14): 12-19, 2008

6 문미영, "당뇨병 환자를 위한 웹기반 족부병변 예방교육 프로그램 개발 및 효과검정" 노인간호학회 12 (12): 154-167, 2010

7 Korean Diabetes Association, "Treatment guideline for diabetes" 12 (12): 10-14, 2011

8 Locke, E. A., "Toward a theory of task motivation and incentives" 3 : 157-189, 1968

9 Campbell, E. M., "The relative effectiveness of educational and behavioral instruction programs for patients with NIDDM : A randomized trial" 22 (22): 379-386, 1996

10 Gerich, J. E., "The rationale for paired pre-and postprandial self-monitoring of blood glucose : The role of glycemic variability in microand macro-vascular risk" 23 (23): 1791-1798, 2007

11 Diabetes Control and Complications Trial Research Group, "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus" 329 (329): 977-986, 1993

12 Davidson, J., "Strategies for improving glycemic control: Effective use of glucose monitoring" 118 (118): 27-32, 2005

13 Karter, A. J., "Self-monitoring of blood glucose levels and glycemic control : The northern california kaiser permanent diabetes registry" 111 (111): 1-9, 2001

14 Delamater, A. M., "Self-monitoring of blood glucose by adolescents with diabetes : Technical skills and utilization of data" 15 (15): 56-61, 1989

15 Sarol, J. N., "Self-monitoring of blood glucose as part of a multi-component therapy among non-insulin requiring type 2 diabetes patients : A meta-analysis(1966-2004)" 21 (21): 173-184, 2005

16 Kirk, J. K., "Self-monitoring of blood glucose : Practical aspects" 4 (4): 435-439, 2010

17 Lee, H. S., "Self-management and accuracy of self-monitoring of blood glucose between patients with diabetic mellitus" Hanyang University 2010

18 Poolsup, N., "Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients; An update" 11 (11): 775-784, 2009

19 Lewis, S. M., "Medical-surgical nursing: Assessment and management of clinical problems" Mosby 2004

20 Schwedes, U., "Meal-related structured self-monitoring of blood glucose" 25 (25): 1928-1932, 2002

21 IDF Clinical Guidelines Task Force, "Global guideline for type 2 diabetes : Recommendations for standard, comprehensive, and minimal care" 23 (23): 579-593, 2006

22 Coonrod, B. A., "Frequency and determinants of diabetes patient education among adults in the U. S. population" 17 (17): 852-858, 1994

23 Mayfield, J., "For the AAFP panel on self-monitoring of blood glucose. self control: A physician's guide to blood glucose monitoring in the management of Diabetes. An American Family Physician Monograph"

24 Graber, A. L., "Evaluation of diabetes patient-education programs" 26 (26): 61-64, 1977

25 UK Prospective Diabetes Study Group, "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes(UKPDS 34)" 352 : 854-865, 1998

26 Choi, Y. J., "Differences in accuracy and utilization of self-monitoring of blood glucose in type 2 Diabetes patients according to education providers" Kyunghee University 2012

27 Fisher, J. D., "Changing AIDS risk behavior" 111 (111): 455-474, 1992

28 Jones, H., "Changes in diabetes self care behaviors make a difference in glycemic control : The Diabetes stages of change study" 26 (26): 732-737, 2003

29 World Health Organization, "Adherence to long term therapies: Evidence for action" World Health Organization 2003