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1형 당뇨병 소아청소년에서 당뇨교육프로그램의 단기효과

Short-term Effect of the Diabetes Education Program in Children and Adolescents with Type 1 Diabetes Mellitus

이선희|김재현|김지영|구민정|박혜영|이영아|신충호|양세원|임한혁|윤인석|강민재
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2010.12|Annals of Pediatric Endocrinology & Metabolism|제15권 제3호|pp. 164-171

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EducationType 1 diabetes mellitus
주제분류소아과학

초록

목 적:당뇨병은 합병증을 예방하고 관리해야 하는 만성 질환으로 좋은 예후를 위해서는 엄격한 혈당 조절이 중요하며 여기에는 행동 수정이 반드시 동반되어야 한다. 저자들은 집중치료에 대한 교육프로그램의 단기 효과 및 영향을 미치는 인자들을 조사하고, 향후 주기적 교육과 지지의 필요성에 대해 알아보고자 본 연구를 시행하였다. 방 법:서울대학교병원에서 1형 당뇨병으로 외래에 다니고 있는 10.0-18.9세의 환자들 중에서 당뇨병 집중치료 교육프로그램에 참여한 30명을 대상으로 하였다. 교육프로그램은 5박 6일 동안 의사, 당뇨전문간호사, 임상영양사, 사회복지사로 구성된 당뇨관리팀에 의해 교육이 이루어졌고 의무기록의 조사를 통해 당뇨병의 유병기간과 입원 당시 시행한 합병증 관련 검사결과를 확인하였으며 교육 전후의 당화혈색소 검사 결과를 분석하였다. 결 과:교육 전후 평균당화혈색소의 변화는 28명의 환자에서 평균 0.9%, 중앙값 0.8%의 의미 있는 감소가 있었고(P˂0.001) 이 변화는 첫교육을 받은 환자들에서 1.5%의 감소로 두드러졌다. 교육 후 3개월째 당화혈색소는 의미 있는 변화를 보였으나(P=0.009) 교육 후 9개월 이후에는 다시 증가하는 경향을 보였다. 교육 전후 평균당화혈색소의 감소는 유병기간과 음의 상관성이 있었다(r=-0.60, P=0.001). 결 론:1형 당뇨병을 가진 소아청소년에서 시행한 집중치료 교육프로그램의 당화혈색소에 대한 단기 효과는 긍정적이었으나 향후 주기적인 교육과 지지는 지속적으로 필요할 것으로 생각된다.

Abstract

Purpose:Diabetes mellitus is a chronic disorder and strict glycemic control, which cannot be successfully obtained without behavior modification, is the most important factor in prevention and management of complications. The purpose of this study was to investigate the short-term effects and associated factors of the diabetes education program and to assess the necessity of regular and structured education and support in diabetic children and adolescents. Methods:Thirty patients (10.0-18.9 years) with type 1 diabetes mellitus (T1DM), attending the diabetes clinic in Seoul National University Children’s Hospital, were included in the diabetes education program with intensified treatment. A six-day-course program was provided by a diabetes care team with doctors, a specialist diabetes nurse, a clinical dietitian, and a social worker. Patient data of disease duration and complication studies at the time of enrollment were reviewed and changes in HbA1c levels before and after the education program were analyzed. Results:In 28 of 30 patients, significant decrease of average HbA1c levels (average 0.9%, median 0.8%, P＜0.001) was observed after education. The changes in average HbA1c levels were prominent in patients who were educated for the first time. On follow-up, HbA1c level at 3 months was significantly decreased (P=0.009) but after 9 months, it tended to increase again. The decrease of average HbA1c levels after education was negatively correlated with disease duration (r=-0.60, P=0.001). Conclusion:The short-term effect of the diabetes education program with intensified treatment in diabetic children and adolescents was optimistic but regular education and support in these patients should be sustained.

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