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研究生:黃綉雯
研究生(外文):Siou-Wun Huang
論文名稱:生活型態介入計畫對第2型糖尿病高危險群的胰島素反應與健康體能之成效
論文名稱(外文):Effects of a Lifestyle Intervention Program on Insulin Responses and Physical Fitness among Clients with High Risk of Developing Type 2 Diabetes Mellitus
指導教授:陳俊忠陳俊忠引用關係
指導教授(外文):Jin-Jong Chen
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:134
中文關鍵詞:生活型態糖尿病胰島素健康體能
外文關鍵詞:lifestylediabetes mellitusinsulinphysical fitness
相關次數:
  • 被引用被引用:7
  • 點閱點閱:363
  • 評分評分:
  • 下載下載:63
  • 收藏至我的研究室書目清單書目收藏:5
研究背景:在台灣,糖尿病的盛行率偏高且治療率偏低,使得糖尿病已成為國人主要的慢性病之一,造成許多併發症和龐大的醫療花費。過去研究指出第2型糖尿病可以經由改變生活型態、規律的身體活動和減輕體重來得到防治的效果。然而,目前較少的文獻資料去評估當生活型態介入時,對第2型糖尿病高危險群的胰島素反應與健康體能之影響成效為何。
目的:本研究目的主要針對第2型糖尿病高危險群,設計生活型態介入計畫,並評估此生活型態介入計畫對第2型糖尿病高危險群的胰島素反應與健康體能之影響。
方法:本研究採用單組,單因子重複測量研究設計(single group, one-way repeated measures design)。研究過程順序包括:前測(0週)、介入(1-20週)、後測(21週)、停止介入(22-44週)與追蹤(45週)。利用美國糖尿病學會建議的第2型糖尿病危險因子,從台北市立陽明醫院員工及志工中篩選出符合本研究收案標準的第2型糖尿病高危險群,共計35位參與者(平均年齡48.5 ± 6.7歲,女性25位,男性10位)。在計畫介入二十週的前後及追蹤第四十五週,每位參與者必須在一週內依序完成:(1)口服葡萄糖耐受性測試,以檢測胰島素反應(敏感性與分泌),並估算出胰島素反應指標。(2)健康體能檢測,包括:身體組成(身高、體重、身體質量指數、體脂肪重、肌肉重、體脂肪百分率)、肌力與肌耐力(握力、腿肌力、腹肌肌力)、柔軟度與心肺耐力(三分鐘登階)。二十週的生活型態介入計畫包括:八週的團體衛教核心課程和十二週的個案管理介入課程。這些參與者被鼓勵在結束介入計畫時,至少減輕起始體重7%,並維持每週150分鐘中等費力的身體活動量(每天累積步數一萬步)。
結果:研究結果發現執行二十週的生活型態介入計畫後,可顯著改善胰島素反應指標;包括:空腹血漿葡萄糖濃度(p=0.04)、120分鐘血漿葡萄糖濃度(p=0.03)、葡萄糖曲線下面積(glucoseAUC) (p=0.05)、胰島素曲線下面積(glucoseAUC) (p=0.01)、胰島素敏感度指標(ISI) (p=0.03)、代謝清除率指標(MCR) (p=0.01)。而在健康體能也有顯著改善,包括:體脂肪重(p=0.01)、體脂肪百分率(p=0.02)與三分鐘登梯心肺耐力指數(p=0.01)。在追蹤第四十五週仍保有顯著改善的數值,包括:空腹血漿葡萄糖濃度(p=0.01)、葡萄糖曲線下面積(p=0.05)、體重(p<0.01)與身體質量指數(p<0.01)。然而在肌力與肌耐力、柔軟度則無看到顯著的改善。
結論:針對第2型糖尿病高危險群進行二十週生活型態介入計劃後,可顯著改善胰島素反應指標與身體組成。而且即使在二十週介入後並未完全顯著改善健康體能與未達到減輕7%起始體重的預定目標,胰島素反應指標仍可有達到改善的效果。本研究結果支持當增加身體活動量和減重兩因素,對第2型糖尿病的高危險群而言,可能為決定胰島素反應(敏感性和分泌)的重要因子。加強二者的改善措施當有助於第2型糖尿病高危險族群的疾病預防。
Background: The high prevalence and low treatment rate of diabetes cause the huge medical cost, and the diabetes has become one of the major chronic disease in Taiwan. The previous researches indicated that type 2 diabetes can be prevented by changing lifestyles, regular physical activity and reducing weight of high-risk clients. However, few studies evaluate the effects of a lifestyle intervention on insulin responses indices and health related physical fitness among clients with high risk of developing type 2 diabetes mellitus.
Purposes: The purposes of this study were (1) to design a lifestyle intervention program for clients with high risk of developing type 2 diabetes mellitus, and (2) to evaluate the effects of the program on insulin responses indices and health related physical fitness.
Methods: The study was single group and one-way repeated measures design. Study processes were pre-test (0 week), intervention (1-20th week), post-test (21th week), none intervention (21th-44th week) and follow-up (45th week). Thirty-five clients with high risk of type 2 diabetes mellitus, based on the diabetes risk factors of American Diabetes Association, were recruited from a local community hospital. They included 25 females and 10 males with mean age of 48.5 years (SD=6.7 years). Before and after the 20weeks intervention, all clients completed the following measurements: (1) oral glucose tolerance test (OGTT) to estimate index of insulin responses (sensitivity and secretion), and (2) Physical fitness measurements including body composition (height, weight, fat weight, body fat percentage and muscle weight), muscle strength and endurance (grip force, leg strength and abdominal muscular endurance), flexibility and cardiorespiratory fitness (3-minute step test). The lifestyle intervention program including a series of 8 weeks group education courses and 12 weeks courses were instructed by well-trained case-managers. The clients were encouraged to lose 7% of initial body weight and to maintain at least 150 minutes per week of physical activity (10,000 steps /day) at the end of program.
Results: After 20 weeks lifestyle intervention program there were significant improvement on insulin responses indices, including fasting plasma glucose (p=0.04), 120 minutes plasma glucose (p=0.03), area under the plasma glucose curve (glucoseAUC) (p=0.05), area under the plasma insulin curve (insulinAUC)(p=0.01), insulin sensitivity index (ISI)(p=0.03), metabolic clearance rate(MCR)(0.01). Significant improvement were also found on physical fitness, including fat weight (p=0.01), body fat percentage (p=0.02) and 3-minute step fitness index (p=0.01). At 45th week follow-up, there were significant improvement on fasting plasma glucose (p<0.01), area under the plasma glucose curve (p=0.05), body weight (p<0.01), body mass index (BMI) (p<0.01). However, there were not significant improvements on the muscle strength and endurance and flexibility.
Discussion and conclusions: After the 20 weeks lifestyle intervention program, there were significant improvements of the insulin responses indices and body composition. Insulin sensitivity may be improved in the absence of improvement in physical fitness and didn’t achieved lost 7% of initial body weight after 20 weeks intervention program. Increasing physical activity and reducing body fat, that are important determinants of insulin responses (sensitivity and secretion), may delay type 2 diabetes proceeding.
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