目的：營養諮詢是糖尿病共同照護網重要一環，過去進行的模式以營養師主導的父權式溝通為主，病人遵從度不佳，進而影響治療目標的達成。本研究目的在探討運用醫病共享決策(Shared Decision Making, SDM)在醫院營養門診進行糖尿病諮詢衛教之初步成效。
研究方法：本研究場域是衛生福利部臺南醫院總院與新化分院之營養門診。收案對象為加入糖尿病共同照護網之病人，其納入條件為：(1)年紀大於等於50歲之中高齡者；(2)以口服降血糖藥控制血糖者；(3)糖化血色素大於等於7者；(4)同意參與研究並簽署受試者同意書者。排除條件有：(1)糖尿病腎病變患者(慢性腎臟疾病第三b期、第四期、第五期)；以及(2)有認知功能障礙者。
以隨機分派將研究對象分至介入組(n=32)與控制組(n=30)。研發醫病共享決策輔助工具(Decision aids)，包含10組控制血糖的行為改變。介入組使用輔助工具，並接受醫病共享決策營養諮詢，步驟如下：(1)向病人說明糖尿病血糖控制之處置方案；(2)提供所有營養治療處方及運動的比較資訊供病人參考；(3)了解病人對飲食處方的偏好或運動的意願；(4)分析各營養治療處方與是否運動的優缺點；(5)支持並激勵病人依其價值觀進行之決策。對照組則依傳統方式進行糖尿病營養諮詢。
在介入前與介入後三個月進行評估，包括飲食頻率問卷、體重、身體質量指數、糖化血色素、低密度脂蛋白膽固醇、三酸甘油酯。並在前測評估行為改變的信心程度與後測評估行為改變的自覺遵從性。
研究結果：介入後，介入組在含糖飲料(Z = 2.01, p = 0.04)與油炸類食品的攝取頻率(Z = 2.22, p = 0.03)較對照組低。介入組的信心程度[OR = 13.29, p = 0.0002, 95% confidence intervals (CI)：3.39-52.15 ]與自覺的遵從性(OR = 7.09, p = 0.0005, 95% CI：2.34-21.52)都較對照組高。醫病共享決策在糖化血色素的介入效果，對糖化血色素超過8%的病人顯著有效，即使在控制藥物作用後，仍然有其成效。
結論：醫病共享決策營養諮詢能提升糖尿病人的信心，做健康生活型態的調整，並提高對健康行為改變的自覺遵從性。但在健康飲食行為與臨床生化指標方面，醫病共享決策營養諮詢只有部分的成效。

Objectives: Nutritional counseling is an important component for diabetes care.
Patients' low adherence to professional counseling may lead to worse treatment outcomes. The aim of this study was to investigate the efficacy of shared decision making (SDM) in nutritional consultant clinics for patients with diabetes mellitus.
Methods: Participants were: patients with diabetes aged 50 or over; taking oral glucose-lowering agents; had glycated hemoglobin (A1C) ≥ 7; and were willing to join the study. Patients with: chronic kidney disease stage III b, IV, or V; or with cognitive impairment were excluded from the study.
Participants were assigned to the experimental group (n=32) and control group (n=30), randomly. The experimental group received SDM counseling with decision aids, while the control group received traditional counseling. The SDM decision aids that demonstrated 10 health behaviors were developed by the researcher. The process of SDM counseling included (1) illustrating the program, (2) providing nutritional and exercise information, (3) recording patients’ preferences about eating behavior and exercise, (4) comparing the strengths and weakness of different eating behaviors and exercise, and (5) supporting patients to make the decisions based on their values.
The data that collected prior to intervention and 3 months afterwards included questions relating to the frequency of consuming different foods, body weight, body mass index, A1C, low-density lipoprotein- cholesterol, and triglycerides. The confidence in behavior change and perceived adherence to behavior change were also evaluated.
Results: After intervention, the experimental group had significantly lower frequency consumption of sugary drinks (Z = 2.01, p = 0.04) and fried foods (Z = 2.22, p = 0.03) than the control group. The experimental group also showed higher confidence [OR = 13.29, p = 0.0002, 95% confidence intervals (CI): 3.39 - 52.15] and perceived adherence (OR = 7.09, p = 0.0005, 95% CI: 2.34 - 21.52). After controlling for medication, SDM intervention still had a positive effect on A1C for patients with A1C levels above 8%. No significant differences in body weight, body mass index, and lipid profile were noted.
Conclusion: SDM in diabetic nutritional counseling increases confidence and perceived adherence to healthy lifestyle modification but only achieves partial success in healthy diet and clinical outcomes.

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