糖尿病患者的戒烟情况：来自印度喀拉拉邦的一项随机对照预试验
2013/03/28
摘要
摘要：印度的糖尿病患者数量居世界第二位（6100万名患者），吸烟者数量也居世界第二（2亿7500万人）。在中低收入国家中，有关糖尿病患者的戒烟研究较少。本试验旨在研究除医生提供的戒烟建议之外，非医生健康专业人士针对糖尿病患者提供的特定戒烟咨询对戒烟的有效性。
方法：在此项平行分组、随机、对照试验中，从印度南部两个糖尿病门诊中选择224名年龄大于18岁的成人糖尿病患者，这些受试者在过去1个月内曾有吸烟。通过电脑生成四联随机序列。受试者随机平均分入干预1组和干预2组。医生要求和建议两组患者戒烟，并提供针对糖尿病患者的宣教资料。在干预2组中，非医生的健康专业人士额外采用5A（询问、建议、评估、帮助和安排）和5R（意义、风险、回报、障碍、重复）方法为受试者提供30 分钟的针对糖尿病患者的戒烟咨询。在6个月时，87.5%的患者仍然受访。戒烟国际项目受到美国国立卫生研究院Fogarty国际中心的资助（RO1TW005969-01）。主要转归为6个月时的戒断率（7天戒烟率）和危害下降率（每天吸烟量较基线水平的下降值> 50%）。
结果：意向治疗分析显示，与干预1组相比，干预2组戒烟的优势比为8.4（95% CI：4.1-17.1）。两组戒烟的优势比相似。与干预1组相比，干预2组危险下降的优势比为1.9（CI: 0.8-4.1）。
结论：由非医生的健康专业人士提供的针对糖尿病患者的符合当地文化的戒烟咨询，是预防与戒烟相关的糖尿病并发症的一种有效方法。本试验在印度临床试验注册网进行注册，注册号为CTRI/2012/01/002327。
（林江涛 审校）
BMC Public Health. 2013 Jan 18;13(1):47. [Epub ahead of print]
Smoking cessation among diabetes patients: results of a pilot randomized controlled trial in Kerala, India.
Thankappan K, Mini G, Daivadanam M, Vijayakumar G, Sarma P, Nichter M.
Abstract
BACKGROUND: India has the second largest diabetic population (61 million) and tobacco users (275 million) in the world. Data on smoking cessation among diabetic patients are limited in low and middle income countries. The objective of the study was to document the effectiveness of diabetic specific smoking cessation counseling by a non-doctor health professional in addition to a cessation advice to quit, delivered by doctors.
METHODS: In our parallel-group randomized controlled trial, we selected 224 adult diabetes patients aged 18 years or older who smoked in the last month, from two diabetes clinics in South India. Using a computer generated random sequence with block size four; the patients were randomized equally into intervention-1 and intervention-2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and distributed diabetes specific education materials. The intervention-2 group received an additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess, Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a non-doctor health professional. Follow up data were available for 87.5% of patients at six months. The Quit Tobacco International Project is supported by a grant from the Fogarty International Centre of the US National Institutes of Health (RO1TW005969-01).The primary outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the number of cigarettes / bidis smoked per day > 50% of baseline use) at six months.
RESULTS: In the intention to treat analysis, the odds for quitting was 8.4 [95% confidence interval (CI): 4.1-17.1] for intervention-2 group compared to intervention-1 group. Even among high level smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1) for intervention-2 group compared to intervention-1 group.
CONCLUSIONS: The value addition of culturally sensitive diabetic specific cessation counseling sessions delivered by non-doctor health professional was an impressive and efficacious way of preventing smoking related diabetic complications.The trial was registered in Clinical Trial Registry of India (CTRI/2012/01/002327).
BMC Public Health. 2013 Jan 18;13(1):47. [Epub ahead of print]
