「全民健康保險糖尿病醫療給付改善方案」對糖尿病患代謝指標及營養素攝取之影響

Effects of medical payment from National Health Insurance on the improvement of metabolic indicators and nutrient intakes in diabetic patients

10.6831/TMU.2008.00132

王馨羚

糖尿病 ； 營養衛教 ； 巨量營養素 ； Diabetic mellitus ； Nutrition Education ； Macronutrient

臺北醫學大學保健營養學研究所學位論文

2008年

碩士

葉松鈴

繁體中文

本研究以參與「全民健康保險糖尿病醫療給付改善方案」之門診糖尿病病患為對象，採用回溯的方式來分析病患一年前後之資料。研究目的有三: 1)瞭解糖尿病病患之飲食營養攝取與體位、血糖、血脂之改善狀況; 2) 瞭解病患接受糖尿病營養衛教一年前後之飲食營養攝取改善狀況; 3)分析經過一年營養衛教後，病患之熱量與巨量營養素的飲食攝取量是否符合美國國家糖尿病學會之建議指標。研究發現接受糖尿病醫療給付改善方案照護一年後，在生化代謝指標部份，糖化血色素(8.8 ± 2.1%與7.8 ± 1.5%)、總膽固醇(210.0 ± 45.4mg/dL與190.3 ± 41.0 mg/dL)、 三酸甘油酯(178.9 ± 157.5mg/dL與158.3 ± 120.9mg/dL)、低密度脂蛋白(129.4 ± 40.0mg/dL與113.4 ± 33.3mg/dL)皆有顯著降低(p<0.05)。此外，在營養素方面，蛋白質(66.7 ± 23.1g降至62.5 ± 16.9g)、脂肪(61.3 ± 24.9g降至56.8 ± 19.1g)和醣類(217.7 ± 61.2g降至205.2 ± 49.1g)的攝取量上皆有顯著降低(p<0.05)，總熱量也從1689.4 ± 466kcal降至1582.5 ± 353.8kcal (p<0.05)。本研究顯示499位糖尿病病患在接受「全民健康保險糖尿病醫療給付改善方案」一年後，血糖、血脂與熱量、巨量營養素攝取皆有顯著改善。

Intergrated shared care model from multi-displine professionals has been found to be effective in management of clinical metabolic indices and prevention of diabetic-related complications. This study included type 2 diabetic patients who have received medical payment from National Health Insurance which includes multi-displine professionals (doctor, nurse and dietitian) as a care team for a year. The purpose of this study was to examine effect of medical payment from National Health Insurance on the improvement of metabolic indicators and nutrient intakes. After one year intervention, HbA1c (8.8 ± 2.1% vs 7.8 ± 1.5%)、cholesterol (210.0 ± 45.4mg/dL vs 190.3 ± 41.0 mg/dL)、triglyceride (178.9 ± 157.5mg/dL vs 158.3 ± 120.9mg/dL) and low density lipoprotein (129.4 ± 40.0mg/dL vs 113.4 ± 33.3mg/dL) have significantly decreased (p<0.05)。Further, amount of calorie intake (kcal/day) (1689.4 ± 466kcal/d vs 1582.5 ± 353.8 kcal/d)、protein intake (g/day) (66.7 ± 23.1g/d vs 62.5 ± 16.9g/d )、fat intake (g/day) (61.3 ± 24.9g/d vs 56.8 ± 19.1g/d) and carbohydrate intake (g/day) (217.7 ± 61.2g/d vs 205.2 ± 49.1g/d) have significantly dropped (p<0.05). In conclusion, the study indicates that after one year nutrition education, there is significant improvement of the status glycemic、Dyslipidemia as well as nutrient intakes. This implies that 499 patient care model composing multi-displine professionals may be beneficial for metabolic control and nutrient intakes.

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