摘要： 背景 智能運(yùn)動(dòng)手環(huán)在慢性病管理中應(yīng)用越來越廣泛，運(yùn)動(dòng)手環(huán)有助于提高患者運(yùn)動(dòng)干預(yù)的依從性和積極性，但運(yùn)動(dòng)手環(huán)在社區(qū)2型糖尿病患者中的長期應(yīng)用效果證據(jù)有待補(bǔ)充。 目的 構(gòu)建社區(qū)2型糖尿病患者使用智能運(yùn)動(dòng)手環(huán)干預(yù)模式，探討智能運(yùn)動(dòng)手環(huán)在社區(qū)2型糖尿病患者中的長期應(yīng)用效果。 方法 于2018年7—8月在廣州市11個(gè)行政區(qū)中各選取1家社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)，然后在每家機(jī)構(gòu)招募2型糖尿病患者10~15例作為干預(yù)組，同時(shí)招募與干預(yù)組年齡相差±2歲、同性別的2型糖尿病患者作為對(duì)照組。于2018年9月至2019年8月對(duì)兩組患者開展干預(yù)，兩組患者均接受家庭醫(yī)生團(tuán)隊(duì)提供的規(guī)范化健康管理服務(wù)，并由運(yùn)動(dòng)處方師開具運(yùn)動(dòng)處方，干預(yù)組患者在此基礎(chǔ)上佩戴智能運(yùn)動(dòng)手環(huán)，依托運(yùn)動(dòng)手環(huán)進(jìn)行健康監(jiān)測和管理，并在運(yùn)動(dòng)處方師的指導(dǎo)下制定個(gè)性化運(yùn)動(dòng)挑戰(zhàn)目標(biāo)。比較兩組患者干預(yù)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(biāo)水平，以及關(guān)鍵指標(biāo)達(dá)標(biāo)率。 結(jié)果 對(duì)照組92例患者、干預(yù)組144例患者完成了1年的干預(yù)和隨訪。干預(yù)后，干預(yù)組患者SDSCA的飲食管理、足部護(hù)理管理維度得分及總得分較干預(yù)前升高（P<0.05），而對(duì)照組患者的得分與干預(yù)前比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）?；€時(shí)，兩組患者各項(xiàng)綜合控制指標(biāo)比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；干預(yù)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(yù)前降低（P<0.05），對(duì)照組患者空腹血糖（FPG）和低密度脂蛋白膽固醇（LDL-C）較干預(yù)前降低、三酰甘油（TG）較干預(yù)前升高（P<0.05），干預(yù)組患者腰圍（WC）較干預(yù)前降低（P<0.05）。在關(guān)鍵指標(biāo)達(dá)標(biāo)率方面，干預(yù)組患者的干預(yù)后糖化血糖蛋白（HbA1c）達(dá)標(biāo)率高于干預(yù)前，且高于對(duì)照組同期數(shù)據(jù)（P<0.05）；兩組患者的干預(yù)后FPG達(dá)標(biāo)率均高于干預(yù)前，但高密度脂蛋白膽固醇（HDL-C）達(dá)標(biāo)率均低于干預(yù)前（P<0.05）。 結(jié)論 使用智能運(yùn)動(dòng)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(dá)標(biāo)。血脂異常是影響血糖控制的重要因素，在調(diào)整生活方式的基礎(chǔ)上，應(yīng)盡早啟動(dòng)藥物干預(yù)以調(diào)節(jié)脂代謝紊亂。

關(guān)鍵詞: 糖尿病，2型, 智能運(yùn)動(dòng)手環(huán), 運(yùn)動(dòng), 自我管理, 可穿戴電子設(shè)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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