志工電話提醒對糖尿病患者血糖控制的成效探討

背景： 糖尿病的治療需要飲食、運動、藥物等三方面的配合，是一種須要長期控制的慢性病。然而，糖尿病患者遵醫囑的行為並不高（25~53%）；研究顯示，自動電話提醒系統確實可使糖尿病患者的血糖管理獲得改善；但由於自動電話提醒所需的經費較多，人力成本也較高，因此擬定本研究。 目的： 本研究採用糖尿病志工定期電話提醒追蹤，期待糖尿病患者遵醫囑行為能有所提高，使血糖控制獲得改善。 方法： 臨床隨機試驗，研究病患為某醫學中心新陳代謝科門診的糖尿病患，共收案100人；採臨床隨機分派至介入組（50人）及對照組（50人），追蹤期為三個月。介入組由糖尿病志工進行定期的電話追蹤提醒，每二星期一次共六次，提醒的內容為遵醫囑行為之執行，對照組則依一般門診的照護程序。 結果： 介入組病患經由介入措施後，在遵藥物醫囑行為及遵飲食醫囑行為方面，皆有顯著的改善（p<.05），其空腹血糖值由227mg/dl降至159ml/dl（p<.05）；在實施介入措施後，介入組空腹血糖值的改善明顯優於對照組（p<.05）。介入組在回診率的平均值為2.84±0.58，介入組的回診率明顯優於對照組（p<.05）。 結論： 電話提醒追蹤能提高糖尿病患者在藥物及飲食方面的遵醫囑行為，且血糖控制得到顯著改善。

Background: Diabetes mellitus is a chronic disease, which should be long-term treated by diet-control, exercise and medication. However, the patient’s compliance to the doctor’s orders is not good. As previous studies showed, auto-telephone-reminder could improve the glycemic control in these patients. Because the cost and manpower will increase by using this system, we conducted the study to evaluate the effect of the volunteer workers-telephone-reminder. Objective: The glycemic control will become better by increase the compliance after regular reminding the diabetic patients by telephone. Methods: All 100 of diabetic outpatients were enrolled from the section of metabolism in the medical center. We randomized these subjects into two groups. There were 50 subjects in the study group and the others in the control group. The follow-up duration was three months. The subjects in the study group were regularly reminded by the workers’ phone calls, and the ones in the control group received the routine nursing protocol for outpatient. Results: After the volunteer workers-telephone-reminder involved in the study group, the compliance of the diet control and medicine were significantly improved. The mean of fasting blood glucose was decrease from 227 mg/dl to 159 mg/dl（p<.05）, and the difference between the two groups is significant. The mean rate of subjects coming back was 2.84 + 0.58 times, and the difference between the two groups was significant. Conclusion: The Volunteer workers telephone-reminder can increase the compliance of diet —control and medicine of diabetic patients. The glycemic control has been significantly improved.