摘要： 背景 智能運動手環(huán)在慢性病管理中應用越來越廣泛，運動手環(huán)有助于提高患者運動干預的依從性和積極性，但運動手環(huán)在社區(qū)2型糖尿病患者中的長期應用效果證據(jù)有待補充。 目的 構建社區(qū)2型糖尿病患者使用智能運動手環(huán)干預模式，探討智能運動手環(huán)在社區(qū)2型糖尿病患者中的長期應用效果。 方法 于2018年7—8月在廣州市11個行政區(qū)中各選取1家社區(qū)衛(wèi)生服務機構，然后在每家機構招募2型糖尿病患者10~15例作為干預組，同時招募與干預組年齡相差±2歲、同性別的2型糖尿病患者作為對照組。于2018年9月至2019年8月對兩組患者開展干預，兩組患者均接受家庭醫(yī)生團隊提供的規(guī)范化健康管理服務，并由運動處方師開具運動處方，干預組患者在此基礎上佩戴智能運動手環(huán)，依托運動手環(huán)進行健康監(jiān)測和管理，并在運動處方師的指導下制定個性化運動挑戰(zhàn)目標。比較兩組患者干預前后的糖尿病自我管理行為量表（SDSCA）得分、糖尿病綜合控制指標水平，以及關鍵指標達標率。 結果 對照組92例患者、干預組144例患者完成了1年的干預和隨訪。干預后，干預組患者SDSCA的飲食管理、足部護理管理維度得分及總得分較干預前升高（P<0.05），而對照組患者的得分與干預前比較，差異無統(tǒng)計學意義（P>0.05）?；€時，兩組患者各項綜合控制指標比較，差異無統(tǒng)計學意義（P>0.05）；干預1年后，兩組患者總膽固醇（TC）、載脂蛋白A1（apoA1）、載脂蛋白B（apoB）較干預前降低（P<0.05），對照組患者空腹血糖（FPG）和低密度脂蛋白膽固醇（LDL-C）較干預前降低、三酰甘油（TG）較干預前升高（P<0.05），干預組患者腰圍（WC）較干預前降低（P<0.05）。在關鍵指標達標率方面，干預組患者的干預后糖化血糖蛋白（HbA1c）達標率高于干預前，且高于對照組同期數(shù)據(jù)（P<0.05）；兩組患者的干預后FPG達標率均高于干預前，但高密度脂蛋白膽固醇（HDL-C）達標率均低于干預前（P<0.05）。 結論 使用智能運動手環(huán)有助于糖尿病患者長期維持自我管理行為，保持血糖控制達標。血脂異常是影響血糖控制的重要因素，在調整生活方式的基礎上，應盡早啟動藥物干預以調節(jié)脂代謝紊亂。

關鍵詞: 糖尿病，2型, 智能運動手環(huán), 運動, 自我管理, 可穿戴電子設備, 長期效果

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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