智能运动手环在社区2型糖尿病患者中的长期应用效果研究
摘要： 背景 智能运动手环在慢性病管理中应用越来越广泛，运动手环有助于提高患者运动干预的依从性和积极性，但运动手环在社区2型糖尿病患者中的长期应用效果证据有待补充。 目的 构建社区2型糖尿病患者使用智能运动手环干预模式，探讨智能运动手环在社区2型糖尿病患者中的长期应用效果。 方法 于2018年7—8月在广州市11个行政区中各选取1家社区卫生服务机构，然后在每家机构招募2型糖尿病患者10~15例作为干预组，同时招募与干预组年龄相差±2岁、同性别的2型糖尿病患者作为对照组。于2018年9月至2019年8月对两组患者开展干预，两组患者均接受家庭医生团队提供的规范化健康管理服务，并由运动处方师开具运动处方，干预组患者在此基础上佩戴智能运动手环，依托运动手环进行健康监测和管理，并在运动处方师的指导下制定个性化运动挑战目标。比较两组患者干预前后的糖尿病自我管理行为量表（SDSCA）得分、糖尿病综合控制指标水平，以及关键指标达标率。 结果 对照组92例患者、干预组144例患者完成了1年的干预和随访。干预后，干预组患者SDSCA的饮食管理、足部护理管理维度得分及总得分较干预前升高（P<0.05），而对照组患者的得分与干预前比较，差异无统计学意义（P>0.05）。基线时，两组患者各项综合控制指标比较，差异无统计学意义（P>0.05）；干预1年后，两组患者总胆固醇（TC）、载脂蛋白A1（apoA1）、载脂蛋白B（apoB）较干预前降低（P<0.05），对照组患者空腹血糖（FPG）和低密度脂蛋白胆固醇（LDL-C）较干预前降低、三酰甘油（TG）较干预前升高（P<0.05），干预组患者腰围（WC）较干预前降低（P<0.05）。在关键指标达标率方面，干预组患者的干预后糖化血糖蛋白（HbA1c）达标率高于干预前，且高于对照组同期数据（P<0.05）；两组患者的干预后FPG达标率均高于干预前，但高密度脂蛋白胆固醇（HDL-C）达标率均低于干预前（P<0.05）。 结论 使用智能运动手环有助于糖尿病患者长期维持自我管理行为，保持血糖控制达标。血脂异常是影响血糖控制的重要因素，在调整生活方式的基础上，应尽早启动药物干预以调节脂代谢紊乱。
关键词: 糖尿病，2型, 智能运动手环, 运动, 自我管理, 可穿戴电子设备, 长期效果
Abstract:
Background
Smart bracelets are increasingly used in chronic disease management, which help improve patient adherence and motivation to exercise interventions, but more evidence for their long-term effectiveness in patients with type 2 diabetes mellitus (T2DM) in the community needs to be explored.
Objective
To develop an intervention model for community-dwelling type 2 diabetes patients using smart bracelets, and to assess its long-term effectiveness in these patients.
Methods
From July to August 2018, this study selected 11 community health institutions from 11 districts of Guangzhou (one from each district) as study settings. And from each setting, 10-15 T2DM patients were selected (intervention group), and were compared to sex-matched and age-matched (+/- two years) T2DM patients (control group). The intervention was carried out from September 2018 to August 2019 in two groups, both received standardized health management services provided by the family physician team and underwent the exercise prescribed by an exercise prescriber. The intervention group additionally received health monitoring and management via wearing a smart bracelet, and set personalized exercise challenge goals under the guidance of an exercise prescriber. The score of the Chinese version of Summary of Diabetes Self-Care Activities Measure (SDSCA-C), comprehensive assessment indicators, and attainment rates of key glycemic indicators were compared between the two groups before and after the intervention.
Results
Ninety-two patients in the control group and 144 patients in the intervention group completed one-year intervention and follow-up. After the intervention, the subscale scores of dietary management and foot care management and the total score of SDSCA-C increased notably in the intervention group (P<0.05), but changed insignificantly in the control group (P>0.05). Two groups had no statistically significant differences in all comprehensive assessment indicators at baseline (P>0.05). After one year of intervention, besides a decrease was found in total cholesterol, apolipoprotein A1 and apolipoprotein B in both groups, a reduction was found in waist circumference in the intervention group, and in fasting plasma glucose (FPG), triacylglycerol and low-density lipoprotein cholesterol in the control group (P<0.05) .In terms of the attainment rate of key indicators, the HbA1c attainment rate increased in the intervention group after intervention (P<0.05), and the post-intervention rate was higher than that of the control group (P<0.05). The FPG attainment rate was higher after intervention in both groups (P<0.05). But the high-density lipoprotein cholesterol attainment rate was lower after intervention in both groups (P<0.05) .
Conclusion
Using a smart bracelet helps people with T2DM maintain self-management behaviors over time and keep their blood sugar at target levels. As dyslipidemia is an important factor affecting blood glucose control, pharmacological interventions should be initiated as early as possible to regulate lipid metabolism disorders in addition to lifestyle modification.
Key words: Diabetes mellitus, type 2, Smart sports bracelets, Exercise, Self-management, Wearable electronic devices, Long term effects
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