Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of an Individually Tailored Program Based on Self-Measurement of Blood Glucose on Health Behavior and HbA1c in Diabetes and Pre-diabetes Patients

자가혈당측정 기반의 개별 맞춤형 프로그램이 당뇨병 및 당뇨병 전단계 환자의 건강행태와 당화혈색소에 미치는 영향

  • 김윤경 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 김보라 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 유은숙 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 윤서영 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 정미정 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 최지혜 (경주시 고혈당.당뇨병 등록교육센터) ;
  • 최재순 (경주시보건소) ;
  • 성현진 (경주시보건소) ;
  • 강영숙 (경주시보건소) ;
  • 이민숙 (경주시보건소) ;
  • 황태윤 (경주시 고혈당.당뇨병 등록교육센터)
  • Received : 2022.03.08
  • Accepted : 2022.04.26
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study was to evaluate the effectiveness of an individually tailored program based on self-measurement of blood glucose on health behavior and HbA1c in diabetes and pre-diabetes patients. Methods: The program consisted of seven sessions for 12 weeks which were carried out every two weeks. Almost all sessions were progressed on untact method except for the first and last session. The 71 subjects were assessed for their knowledge of diabetes, health behavior, the experience of self-measurement of blood glucose, body mass Index (BMI) and hemoglobin A1c (HbA1c) at before and after the program. They were also evaluated on their degree of utilization of blood glucose measurements after the program. Results: Each mean score on their knowledge of diabetes, health behavior and the experience of self-measurement of blood glucose was significantly increased from 14.77, 25.50, and 2.70 to 15.41, 28.40, and 4.81, respectively. Each mean score on both BMI and HbA1c (n=53) was significantly decreased from 24.47kg/m2 and 7.27% to 24.01kg/m2 and 6.67%, respectively. The post-HbA1c had a significant negative correlation(r=-0.415) with the degree of utilization of blood glucose measurements. The degree of utilization of blood glucose measurements had a significant positive correlation(r=0.581) with post-health behavior. Conclusions: The program shows effectiveness in improving HbA1c in Type 2 diabetes and pre-diabetes patients. The post-HbA1c might be related to the degree of utilization of blood glucose measurements which might be related to the health behavior.

본 연구는 2021년 1월에서 10월까지 경주고당센터에서 당뇨병 환자 57명과 당뇨병 전단계 환자 14명을 대상으로 실시한 자가혈당측정 기반의 개별 맞춤형 프로그램의 효과를 확인하기 위하여 수행되었다. 자가혈당측정 기반의 개별 맞춤형 프로그램은 12주 동안 2주 간격으로 7차 교육이 실시되도록 구성되었으며 1차와 7차 교육을 제외한 대부분의 교육은 전화로 진행되었다. 교육내용은 자가혈당측정 및 활용, 올바른 약물복용법, 저혈당 예방과 대처법, 합병증예방과 관리, 당뇨식사관리, 식사일지작성, 식사유형분석 등을 포함하고, 교육시간은 대상자마다 상이하여 20분에서 1시간까지 소요되었다. 프로그램 동안 대상자들은 자가혈당 측정치를 '송아리당뇨' 앱에 기록하였고 담당간호사와 영양사는 기록된 혈당치를 근거로 개별 맞춤형 혈당관리방법을 교육하였다. 교육의 효과를 판정하기 위해 사전, 사후 설문평가 및 당화혈색소 검사가 실시되었다. 당뇨병 지식(20점 만점)은 14.77점에서 15.41점으로, 건강행태(40점 만점)는 25.50점에서 28.40점으로, 자가혈당 측정경험(6점 만점)은 2.70점에서 4.81점으로 증가하였고 모두 통계적으로 유의하였다. 당화혈색소는 1차 평가(n=67명)에서는 7.38%에서 6.73%로, 2차 평가(n=53명)에서는 7.27%에서 6.67%로 감소하였고, 체질량지수도 24.47kg/m2에서 24.01kg/m2로 감소하여 모두 통계적으로 유의하였다. 사후 당화혈색소는 혈당측정치활용도(r=-0.415) 및 사후 건강행태(r=-0.313)와 음의 상관관계가 있었고, 혈당측정치 활용도는 사후 건강행태(r=0.581) 및 사후 당뇨병 지식(r=0.493)과 양의 상관관계가 있었다. 결과적으로 본 프로그램은 당뇨병 환자와 당뇨병 전단계 환자의 혈당관리에 효과적이며, 사후 당화혈색소는 혈당측정치 활용도와 관련성이 있으며 혈당측정치 활용도는 사후 건강행태와 관련성이 있었다. 이러한 연구결과로 볼 때, 자가혈당측정 기반의 개별 맞춤형 프로그램은 대상자들의 혈당관리에 효과적으로 기여한 것으로 사료된다.

Keywords

References

  1. Moon SH, Lee YW, Ham OK, Kim SH. The Effect of the Experience of Diatetes Education on Knowledge, Self-Care Behavior and Glycosylated Demoglobin in Type 2 Diabetic Patients. J Korean Acad Soc Nurs Educ 2014;20(1):81-92 (Korean) https://doi.org/10.5977/JKASNE.2014.20.1.81
  2. Lee SH, Kim HL. Comparision of Health Behaviors, Diabetes Mellitus(DM) Management and Health-related Quality of Life(HRQoL) between DM Groups with and without Diabetic Education Experience. J Agric Med Community Health 2018;43(2):85-96 (Korean) https://doi.org/10.5393/JAMCH.2018.43.2.085
  3. Sim KH, Hwang MS. Effect of Self-Monitoring of Blood Glucose Based Diabetes Self-Management Education on Glycemic Control in Type 2 Diabetes. J Korean Acad Soc Nurs Edu 2013;19(2):127-136 (Korean) https://doi.org/10.5977/JKASNE.2013.19.2.127
  4. Hyun KS, Kim KM, Jang SH. The Effects of Tailored Diabetes Education on Blood Glucose Control and Self-Care. J Korean Acad Nurs 2009;39(5):720-730 (Korean) https://doi.org/10.4040/jkan.2009.39.5.720
  5. Kang HJ. Current Status and Effects of Nutrition Education Programs for Diabetic Patients in Korea. J Korean Diabetes 2018;19(2):106-112 (Korean) https://doi.org/10.4093/jkd.2018.19.2.106
  6. Shin EC. Research Review: Effective of Self-Management Education in Diabetes Patients. J Korean Diabetes 2016;17(3):185-189 (Korean) https://doi.org/10.4093/jkd.2016.17.3.185
  7. Song MS, Song KH, Ko SH, Ahn YB, Kim JS, Shin JH, Cho YK, Yoon KH, Cha BY, Son HY, Lee DH. The Long-term Effect of a Structured Diabetes Education Program for Uncontrolled Type 2 Diabetes Mellitus Patients - a 4-Year Follow-up. J Kor Diabetes Assoc 2005;29(2):140-150
  8. Lee SL. Effects of Nutrition Counseling on Diabetes Management in Type 2 Diabetes Mellitus Patients. J Korean Diet Assoc 2009;15(2):188-196 (Korean)
  9. Kim CG, Chung CH. Effects of Telephone Consulting Program On Self-efficacy and Self-care in NIDDM Patients. Korean J Adult Nursing 2002;14(2):306-314 (Korean)
  10. Kim HS, Cho JH, Kwon HS, Lee JH, Song BR, Oh JA, Yoon KH, Son HY. Establishment of Blood Glucose Monitoring System using Internet. J. Kor Diabetes Asso 2003;27:280-287 (Korean)
  11. Kim CS. Diabetes Management via Internet and Telephone-based Programs. Korean Clinical Diabetes J 2010;11:25-29 (Korean) https://doi.org/10.4093/kcd.2010.11.1.25
  12. Jung JG, Chung EY, Kim YJ, Park HJ, Kim AR, Ban YH, Kim JS, Yoon SJ, Kim SY, Ahn SK, Nam HS. Improvement of Knowledge, Self-Efficacy and Self-Care Behaviors among Diabetic Patients participated in the Education Program of Sejong Center for Hypertension and Diabetes Management. J Agric Med Community Health 2017;42(4):234-243 (Korean) https://doi.org/10.5393/JAMCH.2017.42.4.234
  13. Yang NY. Knowledge, Self Efficacy and Self Care Behavior Regarding Foot Care among Elderly Diabetes Mellitus Patients. J Korean Acad Adult Nurs 2009;21(4):413-422 (Korean)
  14. Park JY, Lee TY, Jang KS, Oh HY. A Study on Blood Glucose Level and Self Management among Community Dwelling TypeII Diabetes Patients. J Korean Acad Adult Nurs 2010;22(3):271-280 (Korean)
  15. Choi EJ. Focused on Diabetes Education Practice of Community Health Centers in Korea. Korean J Health Educ Promot 2014;31(4):11-24 (Korean) https://doi.org/10.14367/kjhep.2014.31.4.11
  16. Kim HS. Management of Diabetes in Coronavirus Disease 2019: Prognosis and Practical Issues. J Korean Diabetes 2020;21(3)120-125 (Korean) https://doi.org/10.4093/jkd.2020.21.3.120
  17. Kim HY, Kim HS. Factors Affecting the Control of HbA1c in Type 2 Diabetic Patients. Journal of Convergence for Information Technology 2018;8(6):75-84 (Korean) https://doi.org/10.22156/CS4SMB.2018.8.6.075
  18. Kim YJ, Cho EH. Lifestyle factors related to glucose control for diabetes management strategies: Nested case control design using KNHANES data. Journal of the Korea Convergence Society 2019;10(11):501-510 (Korean) https://doi.org/10.15207/JKCS.2019.10.11.501
  19. Park JY, Ko IS, Development of a Comprehensive Self-Management Program Promoting Self Efficacy for Type 2 Diabetic Patients. J Korean Acad Fundam Nurs 2012;19(1):74-86 (Korean) https://doi.org/10.7739/jkafn.2012.19.1.074
  20. Sim KH. Effective Diabetes Self-Management Education: Focus on Blood Glucose Pattern Management. J Korean Diabetes 2016;17(1):35-40 (Korean) https://doi.org/10.4093/jkd.2016.17.1.35
  21. Kim SH, Kim YB, Kim EJ, An JH. Hypertension Diabetes Health Counseling Manual. Seoul, Korea Disease Control and Prevention Agency, 2016, pp.80-85 (Korean)
  22. Lee JA, Park HJ. Relationships between Diabetic Knowledge, Self-Care Behaviors and HbA1c in Diabetic Patients using public hospitals. J Korean Acad Fundam Nurs 2014;21(3): 243-252 (Korean) https://doi.org/10.7739/jkafn.2014.21.3.243
  23. Yoo JS, Lee SJ, Lee HC, Kim SH, Kang ES, Park EJ. The Effects of Short Term Comprehensive Life Style Modification Program on Glycemic Metabolism, Lipid Metabolism and Body Composition in Type 2 Diabetes Mellitus. J Korean Acad Nurs 2004;34(7):1277-1287 (Korean) https://doi.org/10.4040/jkan.2004.34.7.1277
  24. Kang KJ, Yu SJ, Seo HM, Yu M, Park MS, Jang HC. Factors Influence Self Management Behavior for Patients with Type 2 Diabetes: Comparison of Difference between the Elderly and Adults. J Korean Biol Nurs Sci 2012;14(2):112-121 (Korean) https://doi.org/10.7586/jkbns.2012.14.2.112