임상간호연구 (Journal of Korean Clinical Nursing Research)

  • 제28권3호
  • /
  • Pages.277-288
  • /
  • 2022
  • /
  • 1598-9186(pISSN)
  • /
  • 2287-3694(eISSN)
병원간호사회 (Hospital Nurses Association)
권호 표지
DOI QR코드

DOI QR Code

제2형 당뇨병 환자를 위한 인슐린치료이행증진 프로그램의 효과: 무작위대조군실험설계

Effects of the Insulin Therapy Adherence Program for Patients with Type 2 Diabetes: A Randomized Controlled Trial

  • 박경민 (대구가톨릭대학교 간호대학) ;
  • 손정태 (대구가톨릭대학교 간호대학.간호과학연구소 )
  • Park, Kyung Min (College of Nursing, Daegu Catholic University) ;
  • Son, Jung Tae (College of Nursing.Research Institute of Nursing Science, Daegu Catholic University)
  • 투고 : 2022.09.30
  • 심사 : 2022.10.24
  • 발행 : 2022.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: This study was conducted to evaluate the effects of the insulin therapy adherence program (INSTA GRAM) for patients with type 2 diabetes mellitus. Methods: This study examined a total of 63 patients with type 2 diabetes for whom the initiation of insulin therapy is being considered or within 6 months of undergoing insulin therapy. INSTAGRAM is a stage-specific intervention consisting of strategies for motivating patients to initiate and maintain insulin therapy using the transtheoretical model on the stages of change, the process of change, and self-efficacy. The participants were randomly assigned to either the INSTAGRAM group (experimental group, n=32) or the standard diabetes education group (control group, n=31). The INSTAGRAM group received 6 sessions over 8 weeks(face-to-face education was conducted in the first and last sessions, and telephone coaching was conducted from the second to fifth sessions). The outcomes were measured by psychological insulin resistance, self-efficacy, and glycosylated hemoglobin (HbA1c). Results: Psychological insulin resistance (p<.001), self-efficacy (p<.001), and HbA1c (p=.024) of the participants in the INSTAGRAM group significantly improved compared to those in the control group. Conclusion: INSTAGRAM is effective in overcoming psychological insulin resistance and improving self-efficacy and HbA1c. Therefore, the INSTAGRAM can be recommended as a nursing intervention for type 2 diabetic patients who delay the initiation of insulin therapy.

키워드

참고문헌

  1. Hur KY, Moon MK, Park JS, Kim SK, Lee SH, Yun JS, et al. 2021 Clinical practice guidelines for diabetes mellitus in Korea. Diabetes & Metabolism Journal. 2021;45(4):461-481. https://doi.org/10.4093/dmj.2021.0156
  2. Korean Diabetes Association. 2019 Treatment guideline for diabetes [Internet]. Seoul: Korean Diabetes Association; 2019 Jun 21 [cited 2022 Oct 28]. Available from: https://www.diabetes.or.kr/newsletter/2019/file/mail_190520_file1.pdf.
  3. Lee JR. Evidence for questions by diabetes educators when teaching insulin injection in clinical practice. Journal of Korean Diabetes. 2017;18(2):109-116. https://doi.org/10.4093/jkd.2017.18.2.109
  4. Chan WB, Chen JF, Goh SY, Vu TT, Isip-Tan IT, Mudjanarko SW, et al. Challenges and unmet needs in basal insulin therapy: Lessons from the Asian experience. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2017;10:521-532. https://doi.org/10.2147/DMSO.S143046
  5. Kim SG, Kim NH, Ku BJ, Shon HS, Kim DM Park TS, et al. Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea. Journal of Diabetes Investigation. 2016;8(3):346-353. https://doi.org/10.1111/jdi.12581
  6. Bae JH, Han KD, Ko SH, Yang YS, Choi JH, Choi KM, et al. Diabetes fact sheet in Korea 2021. Diabetes & Metabolism Journal. 2022;46(3):417-426. https://doi.org/10.4093/dmj.2022.0106
  7. Polonsky WH, Arsenault J, Fisher L, Kushner P, Miller EM, Pearson TL, et al. Initiating insulin: How to help people with type 2 diabetes start and continue insulin successfully. International Journal of Clinical Practice. 2017;71(8):e12973. https://doi.org/10.1111/ijcp.12973
  8. Nigg CR, Geller KS, Motl RW, Horwath CC, Wertin KK, Dishman RK. A research agenda to examine the efficacy and relevance of the transtheoretical model for physical activity behavior. Psychology of Sport and Exercise. 2011;12(1):7-12. https://doi.org/10.1016/j.psychsport.2010.04.004
  9. Son HG, Jeong KS. Influence of non-compliance of treatment and family support on depression in diabetic patients with hypoglycemia. Journal of the Korea Contents Association. 2018;18(6):518-528. https://doi.org/10.5392/JKCA.2018.18.06.518
  10. Kim SK. Management of type 2 diabetes mellitus in the elderly. Journal of Korean Diabetes. 2018;19(4):200-207. https://doi.org/10.4093/jkd.2018.19.4.200
  11. Shin SR. Self efficacy theory applied in nursing practice. Journal of Nursing Query. 2006;15(1):88-105.
  12. Kim SO. The development and effects of a medication adherence intervention program for hypertensive patients. Journal of Korean Academy of Community Health Nursing. 2011;22 (3):342-354. https://doi.org/10.12799/jkachn.2011.22.3.342
  13. Guo XH, Ji LN, Lu JM, Liu J, Lou QQ, Liu J et al. Efficacy of structured education in patients with type 2 diabetes mellitus receiving insulin treatment. Journal of Diabetes. 2014;6(4): 290-297. https://doi.org/10.1111/1753-0407.12100
  14. DiClemente CC. Conceptual models and applied research: The ongoing contribution of the transtheoretical model. Journal of Addictions Nursing. 2005;16(1):5-12. https://doi.org/10.1080/10884600590917147
  15. Cho JH. Development and feasibility study of motivational interviewing program for type 2 diabetes [dissertation]. Daejeon: Chungnam National University; 2018. p. 1-137.
  16. Hong SH, Kim MJ, Noh SG, Suh DW, Youn SJ, Lee KW, et al. A study on resistance in type 2 diabetic patient against commencement of insulin treatment. Korean Diabetes Journal. 2008;32(3):269-279. https://doi.org/10.4093/kdj.2008.32.3.269
  17. Kang MR. Relationships among psychological insulin resistance, diabetes knowledge and self-efficacy in patients with type 2 diabetes [master's thesis]. Seoul: Yonsei University; 2014. p. 1-71.
  18. Nakaue J, Koizumi M, Nakajima H, Okada S, Mohri T, Akai Y, et al. Development of a self-efficacy questionnaire, 'Insulin Therapy Self-efficacy Scale (ITSS)', for insulin users in Japanese: The Self-Efficacy-Q study. Journal of Diabetes Investigation. 2019;10(2):358-366. https://doi.org/10.1111/jdi.12914
  19. Allen NA, Zagarins SE, Feinberg RG, Welch G. Treating psychological insulin resistance in type 2 diabetes. Journal of Clinical & Translational Endocrinology. 2017;7:1-6. https://doi.org/10.1016/j.jcte.2016.11.005
  20. Jang YJ. Psychological insulin resistance: Key factors and intervention. Journal of Korean Diabetes. 2021;22(3):192-196. https://doi.org/10.4093/jkd.2021.22.3.192
  21. Spence MM, Makarem AF, Reyes SL, Rosa LL, Nguyen C, Oyekan EA, et al. Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease. Journal of Managed Care & Specialty Pharmacy. 2014;20(10): 1036-1045. https://doi.org/10.18553/jmcp.2014.20.10.1036
  22. Lauffenburger J, Lewey J, Jan S, Makanji S, Ferro C, Krumme A, et al. Effect of targeted insulin adherence interventions for glycemic control with predictive analytics: The TARGIT-diabetes randomized clinical trial. Circulation. 2018;138(Suppl 1):A11795.
  23. Kim CJ. Detailed overview and clinical implications of the transtheoretical model. Journal of Nursing Query. 2006;15(1): 48-71.
  24. Chang SO, Kim EJ, Kil SY, Seomun GA, Lee SJ. Influential variables on intention and action to quit smoking between adolescent smokers and adult smokers-based on the transtheoretical model. Journal of Korean Academy of Nursing. 2005;35(8):1410-1419. https://doi.org/10.4040/jkan.2005.35.7.1410
  25. Bandura A, Adams NE. Analysis of self-efficacy theory of behavioral change. Cognitive Therapy and Research. 1977;1(4): 287-310. https://doi.org/10.1007/BF01663995
  26. Walker EA, Shmukler C, Ullman R, Blanco E, Scollan-Koliopoulus M, Cohen HW. Results of a successful telephonic intervention to improve diabetes control in urban adults: a randomized trial. Diabetes Care. 2011;34(1):2-7. https://doi.org/10.2337/dc10-1005
  27. Kang HY, Gu MO. Development and effects of a motivational interviewing self-management program for elderly patients with diabetes mellitus. Journal of Korean Academy of Nursing. 2015;45(4):533-543. https://doi.org/10.4040/jkan.2015.45.4.533
  28. Baser O, Tangirala K, Wei W, Xie L. Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs. ClinicoEconomics and Outcomes Research. 2013;5:497-505. https://doi.org/10.2147/CEOR.S49279