Telefonintervention bei Typ-2-Diabetikern

Zusammenfassung

Hintergrund und Fragestellung: Adipositas, Diabetes und die damit verbundenen Belastungen für das Gesundheitssystem nehmen in der westlichen Industriegesellschaft kontinuierlich zu. In verschiedenen Untersuchungen konnte durch Telefonintervention das Gesundheitsverhalten von Diabetikern verbessert werden.

Patienten und Methodik: Wir untersuchten die Auswirkung einer 3-monatigen Telefonintervention mit einem wöchentlichen Anruf auf Bewegungsverhalten und verschiedene kardiovaskuläre Risikofaktoren bei Patienten mit Diabetes mellitus Typ 2. Verglichen wurde eine Interventionsgruppe (n = 22) mit einer Kontrollgruppe (n = 19), die keine Anrufe erhielt.

Ergebnisse: Bewegungsverhalten und Aktivitätsumfang nahmen in der Interventionsgruppe deutlich zu, in der Kontrollgruppe kam es zu einer Abnahme beider Parameter.

Für Körpergewicht, Body-Mass-Index (BMI), Taillenumfang, Körperfett, systolischen und diastolischen Blutdruck, Triglyceride, HDL-, LDL- und Gesamtcholesterin kam es in der Interventionsgruppe zu stärkeren Verbesserungen als in der Kontrollgruppe.

Folgerung: Mittels einer wöchentlichen telefonischen Abfrage des Bewegungsverhaltens über 3 Monate kann gesundheitsbewusstes Verhalten gesteigert und das kardiovaskuläre Risikoprofil verbessert werden. Der Effekt bei längerfristiger Anwendung sowie Möglichkeit und Ausmaß einer Kostenersparnis für das Gesundheitssystem sollten überprüft werden.

Summary

Background and Objective: While there are evermore therapeutic options, a continuous rise in the prevalence of type 2 diabetes mellitus has been demonstrated in epidemiological studies and is leading to an increasing financial burden on health care systems. It has been shown in a number of studies that health-related lifestyle may be influenced by a telephone intervention program.

Patients and Methods: The effect of a telephone intervention on physical activity and other important cardiovascular risk factors was investigated over a period of three months in patients with type 2 diabetes. Those in the intervention group (n=22) were phoned once weekly and only matters concerning their physical activity were discussed. The patients in a matching control group (n=20) were not phoned.

Results: Physical activity increased in the intervention group with a significant difference when compared to the control group at the end of the three months' intervention. At the end of the intervention weight, body mass index, waist circumference, systolic blood pressure, triglycerides and fasting blood sugar where either significantly different between the intervention and control groups (absolute values) or showed a significantly greater decrease in the intervention group. In addition there was a tendency (not statistically significant) towards an improvement in the intervention group regarding other risk factors (body fat, diastolic blood pressure, total cholesterol, LDL, HDL, HbA1c).

Conclusions: These results demonstrate that a telephone intervention can increase physical activity and reduce cardiovascular risk factors. As a result it may reduce health care-related costs.

Schlüsselwörter

Diabetes - Adipositas - Hypertonie - Telefonintervention - Körperliche Aktivität - Kardiovaskuläre Risikofaktoren - Gesundheitssystem

Keywords

diabetes - overweight - hypertension - telephone intervention - physical activity - cardiovascular risk factors - health care system

Literatur

• 1 Ackermann R T, Marrero D G, Hicks K A. et al . An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes.  Diab Care. 2006;  29 1237-41
• 2 Ainsworth B E, Haskell W L, Leon A S. et al . Compendium of physical activities: Classification of energy costs of human physical activities.  Med Sci Sports Exerc. 1993;  25 71-80
• 3 Albright C L, Pruitt L, Castro C, Gonzalez A, Woo S, King A C. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project.  Ann Behav Med. 2005;  30 191-200
• 4 Taylor C B, Miller N H, Reilly K R. et al . Evaluation of a nurse-care management System to improve outcomes in patients with complicated diabetes.  Diab Care. 2003;  26 1058-63
• 5 Berg A, König D. Aspekte zur Prävention und Therapie von Stoffwechselstörungen unter besonderer Berücksichtigung des metabolischen Syndroms.  Dtsch Zeitschr f Sportmed. 2005;  56 74-82
• 6 Blair S N, Kohl H W, Paffenbarger R S, Clark D G, Cooper K H, Gibbons L W. Physical fitness and all-cause mortality. A prospective study of healthy men and women.  JAMA. 1989;  262 2395-401
• 7 Delahanty L M, Conroy M B, Nathan D M. Diabetes Program Research Group, Psychological predictors of physical activity in the diabetes prevention program.  J Am Diet Assoc. 2006;  106 698-705
• 8 Despres J P, Lemieux I, Prud’homme D. Treatment of Obesity: need to focus on high risk abdominally obese patients.  BMJ. 2001;  322 716-20
• 9 Donahue K E, Mielenz T J, Sloane P D, Callahan L F, Devellis R F. Identifying supports and barriers to physical activity in patients at risk for diabetes.  Prev Chronic Dis. 2006;  3 A119
• 10 Ford E S, Giles W H. A comparison of the prevalence of the metabolic syndrome using two proposed definitions.  Diab Care. 2003;  26 575-581
• 11 Hu G, Eriksson J, Barengo N C. et al . Occupational, commuting and leisure-time physical activity in relation to total and cardiovascular mortality among Finnish subjects with type 2 diabetes.  Circulation. 2004;  110 666-73
• 12 Hu G, Lindstrom J, Valle T T. et al . Physical activity, body mass index and risk of type 2 diabetes in patients with normal or impaired glucose regulation.  Arch Intern Med. 2004;  164 892-6
• 13 Ketelhut R G. Körperliche Aktivität zur Behandlung des arteriellen Hochdrucks.  Dtsch Aerztebl. 2004;  101 2896-901
• 14 Kirkman M S, Weinberger M, Landsman P B. et al . A telefone-delivered intervention for patients with NIDDM. Effect on coronary risk factors.  Diab Care. 1994;  17 840-6
• 15 Lickvers K, Kottmair S, Rose I, Müller M, Middeke M. Ergebnisse aus dem Gesundheitsprogramm Hypertonie der Deutschen Krankenversicherung (DKV).  Dtsch Med Wschr. 2005;  130 2628-30
• 16 Liebl A, Neiß A, Spannheimer A. et al . K des Typ-2-Diabetes in Deutschland.  Dtsch Med Wschr. 2001;  126 585-9
• 17 Lithell H, Hansson L, Skoog I. et al . The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind interventional trial.  J Hypertens. 2003;  21 (5) 875-86
• 18 Norris S L, Engelgau M M, Narayan K M. Effectiveness of self-management training in type2diabetes: a systematic review of randomized controlled trials.  Diab Care. 2001;  24 561-87
• 19 Piette J D, Weinberger M, Kraemer F B, McPhee S J. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs Health Care System: a randomized controlled trial.  Diab Care. 2001;  24 202-8
• 20 Piette J D, Weinberger M, McPhee S J. The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial.  Med Care. 2000;  38 218-30
• 21 Piette J D, Weinberger M, McPhee S J, Mah C A, Kraemer F B, Crapo L M. Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?.  Am J Med. 2000;  108 20-7
• 22 Pinto B M, Friedman R, Marcus B H, Kelley H, Tennstedt S, Gillman M W. Effects of a computer-based telephone-counseling system on physical activity.  Am J Prev Med. 2002;  23 113-20
• 23 Plotnikoff R C, Taylor L M, Wilson P M. et al . Factors accociated with physical activity in Canadian adults with diabetes.  Med Sci Sports Exerc. 2006;  38 1526-34
• 24 Ross R, Dagnone D, Jones P J. et al . Reduction in Obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men.  Ann Intern Med. 2000;  133 92-103
• 25 Snyder J W, Malaskovitz J, Griego J, Persson J, Flatt K. Quality improvement and cost reduction realized by a purchaser through diabetes disease management.  Dis Manag. 2003;  6 233-241
• 26 Statistisches Bundesamt .www.destatis.de. 2004
• 27 Tuomilehto J, Lindstrom J, Eriksson J G. et al . Prevention of type2diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-50
• 28 Villegas R, Shu X O, Li H. et al . Physical activity and the incidence of type 2 diabetes in the Shanghai women’s heath study.  Int J Epidemiol. 2006;  35 1553-62
• 29 Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes.  Diabetes Care. 2004;  27 1047-53
• 30 World Health Organization .www.who.int. 2003