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

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「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

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 ± 61.2 g 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。

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

Intergrated shared care model from multi-displine professionals has been found to b e effective in management of clinical metabolic indices and prevention of diabetic-r elated complications. This study included type 2 diabetic patients who have receive d medical payment from National Health Insurance which includes multi-displine p rofessionals (doctor, nurse and dietitian) as a care team for a year. The purpose of t his study was to examine effect of medical payment from National Health Insuranc e on the improvement of metabolic indicators and nutrient intakes. After one year i ntervention, 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/d L) and low density lipoprotein (129.4 ± 40.0mg/dL vs 113.4 ± 33.3mg/dL) have sig nificantly 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 v

s 62.5 ± 16.9g/d ) 、 fat intake (g/day) (61.3 ± 24.9g/d vs 56.8 ± 19.1g/d) and carbo

hydrate intake (g/day) (217.7 ± 61.2g/d vs 205.2 ± 49.1g/d) have significantly drop

ped (p<0.05). In conclusion, the study indicates that after one year nutrition educati

on, there is significant improvement of the status glycemic 、 Dyslipidemia as well

as nutrient intakes. This implies that 499 patient care model composing multi-displi

ne professionals may be beneficial for metabolic control and nutrient intakes.

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