Efekat strukturiranog edukativnog programa o tipu 2 dijabetesa u primarnoj zdravstvenoj zaštiti na zdravstveno ponašanje i glikoregulaciju pacijenata

Abstract

Dijabetes melitus je metaboliĉki poremećaj koji karakteriše hroniĉna hiperglikemija i predstavlja veoma ozbiljan javno-zdravstveni problem u celom svetu. Najveći potencijal za poboljšanje zdravlja obolelih leţi u postizanju i odrţavanju optimalne glikoregulacije. Podaci iz literature pokazuju da se sprovođenjem strukturiranih edukativnih programa o tipu 2 dijabetesa postiţu pozitivni efekti na zdravstveno ponašanje i glikoregulaciju kod obolelih koji su pohađali edukaciju. Cilj ovog istraţivanja bio je da se proceni efekat strukturirane edukacije o tipu 2 dijabetesa u primarnoj zdravstvenoj zaštiti na promenu nivoa znanja, zdravstveno ponašanje, antropometrijske i biohemijske parametre glikoregulacije pacijenata. Istraživanje je sprovedeno u vidu prospektivne studije od februara do avgusta 2018. godine u Savetovalištu za dijabetes Doma zdravlja Subotica. Ispitivanje je obuhvatilo 91 pacijenta sa dijagnostikovanim tipom 2 dijabetesa. Ispitanici su pohađali strukturirani šestonedeljni grupni edukativni program, kreiran za potrebe ovog istraţivanja. U cilju procene efekata edukativnog programa, na poĉetku i ĉetiri meseca nakon edukacije, prikupljeni su podaci o: zdravstvenom ponašanju, nivou znanja o dijabetesu (Diabetes Knowledge Test), o aktivnostima samonege u prethodnih sedam dana (The Summary of Diabetes Self-Care Activities) i o aktivnostima samonege prethodnih osam nedelja (The Diabetes Self-Management Questionnaire), određeni su antropometrijski (telesna teţina, indeks telesne mase, obim struka i nivo arterijskog krvnog pritiska) i biohemijski parametri glikoregulacije (nivo šećera u krvi našte, dva sata nakon jela, nivo HbA1c) i lipidni status pacijenata. Na početku strukturirane edukacije 79% pacijenata imalo je nizak nivo znanja o dijabetesu, prosečna vrednost na DKT bila je 46,4%. Nivo samonege pacijenatna bio je nizak i prethodnih 7 dana (SDSCA 45,8%) i prethodnih 8 nedelja (DSMQ 6,75). Trećina (35%) pacijenata imala je prekomernu telesnu masu, a njih 45% bilo je gojazno (BMI 29,85±5,47). Povišene vrednosti sistolnog krvnog pritiska imalo je 43%, a dijastolnog 54% pacijenata. Polovina (54,9%) pacijenata imala je idealnu glikoregulaciju (HbA1c 6,56±0,96%). Trećina (35%) pacijenata imala je visokorizičan nivo holesterola, a 26% visokoriziĉan nivo triglicerida u krvi. Ispitivanja sprovedena ĉetiri meseca nakon strukturirane edukacije pokazuju značajno povišen nivo znanja pacijenata o dijabetesu, tj. visok nivo sa prosečnom vrednošću DKT 81,5%. Nivo aktivnosti samonege prethodnih 7 dana i prethodnih 8 nedelja dostigao je umeren nivo (SDSCA 57,7%; DSMQ 7,9). Utvrđeno je značajno smanjenje telesne mase pacijenata za 1,5 kg i indeksa telesne mase, BMI, za 0,58 kg/m2. Procenat gojaznih pacijenata smanjen je na 40%. Povišene vrednosti sistolnog krvnog pritiska imalo je 26,4% (uz proseĉno smanjenje od 4 mmHg), a dijastolnog krvnog pritiska kod 44% pacijenata (uz prosečno smanjenje od 3 mmHg). Utvrđeno je znaĉajno smanjenje nivoa HbA1c za 0,36%, idealnu glikoregulaciju postiglo je 68% pacijenata. Zabeleţeno je smanjenje nivoa ukupnog holesterola za 0,3 mmol/L i nivoa triglicerida u krvi pacijenata za 0,23 mmol/L. Broj pacijenata sa visokorizičnim nivoom holesterola smanjen je za 19,6%, a u visokoriziĉnoj kategoriji triglicerida za 12%. Rezultati studije ukazuju da su efekti strukturiranog edukativnog programa o tipu 2 dijabetesa u primarnoj zdravstvenoj zaštiti značajni, povećani su nivoi znanja i aktivnosti samonege, znaĉajno je smanjena telesna masa, vrednosti arterijskog krvnog pritiska su smanjene a poboljšane su vrednosti pokazatelja glikoregulacije i lipidnog statusa pacijenata.

Diabetes Mellitus is a metabolic disorder characterised by chronic hyperglycaemia and is a very serious public health issue worldwide. Achieving and maintaining optimal glucoregulation represents major potential for the improvement of affected persons’ health. According to information available in relative literature, the implementation of restructured Type 2 diabetes education programmes, positive results on health behaviour and glucoregulation in persons who took part in the education. The objective of the research was to assess the effect of structured education on Type 2 diabetes in primary health care, on changes in the level of knowledge, health behaviour and the anthropometric and biochemical parameters of patients’ glucoregulation. The research was conducted in the form of a prospective study between February and August 2018 in the Diabetes Support Group of the Subotica Health Centre. The research included 91 patients who were diagnosed with Type 2 diabetes. Research subjects attended a structured six-week group educational programme, which was specifically developed for the purpose of this research. In order to assess the effects of this educational programme from its outset and four months following the education, data concerning the following were gathered: health behaviour, level of knowledge on diabetes (Diabetes Knowledge Test - DKT), self care activities in the past seven days (The Summary of Diabetes Self-Care Activities - SDSCA) and self care activities in the past eight weeks (The Diabetes Self-Management Questionnaire - DSMQ). These data were anthropomorphic measurements (weight, height, waist circumference and the level of arterial blood pressure) and biochemical glucoregulation parameters (blood sugar levels on an empty stomach, two hours after a meal, HbA1c levels) and patient lipid status. When the structured education first started, 79% patients had a low level of knowledge on diabetes, and the average score at the DKT was 46.4%. The level of patient self care was also low in the past seven days (SDSCA 45.8%) and past eight weeks (DSMQ 6.75%). One third (35%) of patients had excess body mass, of whom 45% were obese (Body Mass Index – BMI 29.85±5.47). 43% of patients had higher systolic blood pressure values while 54% had higher diastolic blood pressure values. In one half of patients (54.9%), glucoregulation was ideal (HbA1c 6.56±0.96%). One third of patients (35%) had highly elevated cholesterol levels, with 26% who had highly elevated triglyceride blood levels. Research conducted during the four-month structured education show a significantly higher level of patient knowledge of diabetes, i.e. high level with the average DKT score of 81.5%. The level of self care activities in the past seven days and eight weeks reached a moderate level (SDCA 57.7%; DSMQ 7.9). A significant reduction in body mass by 1.5 kg as well as Body Mass Index, BMI by 0.58 kg/m2 was determined. The percentage of obese patients was reduced to 40%. 26.4% of patients had increased values of systolic blood pressure (with an average reduction of 4 mmHg), diastolic blood pressure 44% of patients (with an average reduction of 3 mmHg). A significant reduction in HbA1c level by 36% was determined, while 68% of patients achieved ideal glucoregulation. The reduction of total cholesterol level by 0.3% mmol/L as well as triglycerides level by 0.23% mmol/L was recorded. The number of patients with a high-risk cholesterol level was reduced by 19.6%, and the number of patients in high-risk category of triglycerides by 12%. The results of the study indicate that the effects of a structured educational programme on Type 2 diabetes in primary health care are significant. Knowledge levels were increased along with self care activities, body mass was significantly reduced, arterial blood pressure values were reduced and glucoregulation and lipid status values improved.