糖尿病患者的上肢感覺動作功能缺損近年來逐漸被驗證及受到關注，但糖尿病前期患者的上肢功能是較少被關注的。過去研究發現未達到糖尿病前期標準的族群中，其肌肉量會隨著血糖的控制不佳而減少。雖然大部分的研究提出血糖控制與上肢功能及肌肉量之間是相關的，但上肢功能與肌肉量之間的關係，及糖尿病前期與糖尿病的上肢功能和肌肉量的差別仍是不清楚的。第一部分的研究（Chapter 2）的目的為了解糖尿病及糖尿病前期的肌肉量及上肢功能。本研究一共招募了二十七位參與者，並依據其糖化血紅蛋白濃度分配至控制組、糖尿病前期組和糖尿病組。研究過程中會評估參與者的肌肉量、上肢的感覺能力、肌肉力量、敏捷度及感覺動作功能。在比較三組之間差異時使用了克-瓦二氏單因子等級變異數分析和曼惠特尼U考驗。在探討上肢功能與肌肉量的關係時使用了皮爾森和斯皮爾曼等級相關係數。本研究結果發現糖尿病組的上肢感覺、敏捷度及肌肉力量比糖尿病前期組有明顯的較差。另外，本研究也發現高血糖組的肌肉量與上肢肌肉量有正相關，並與手部力量控制有正相關。與血糖控制相關的糖尿病併發症有可能導致了本研究發現的糖尿病組與糖尿病前期組上肢功能差異。肌肉量與肌肉力量之間的關聯性在過去研究常被探討，但本研究發現的肌肉量與力量控制的背後機制仍缺乏深入的探討。因此，未來研究應著重與對糖尿病上肢功能的預防及介入的方法。
對於糖尿病併發症導致的上肢功能缺損，運動是良好的介入方法，而居家模式的運動適用於建立長時間的運動習慣。此外，本體感覺神經肌肉誘發運動及肌腱滑動運動有助於上肢功能的提升。然而，目前仍無研究探討這些運動對於糖尿病患者上肢感覺動作功能的療效。第二部分的研究（Chapter 3）的目的為探討本體感覺神經肌肉誘發運動（PNF）以及合併肌腱滑動運動之綜合運動對於糖尿病患者上肢感覺動作功能的療效。本研究招募了十位糖尿病患者，並隨機分配至控制組、PNF組和綜合組。PNF組的參與者完成了十二周的PNF運動，而綜合組則完成了十二週的PNF合併肌腱滑動運動的綜合運動。兩組運動組的運動內容為完成指定動作三組各十次，每天兩次，每週三天，並持續十二週。在開始運動介入前、介入十二週後及介入二十四週後將會進行各別一次的上肢功能評估。上肢功能評估包含了神經傳導檢查、感覺能力、肌肉力量、敏捷度和感覺動作功能評估。在比較組內三個時間點功能差異時使用了弗理曼二因子等級變異數分析和Wilcoxon等級和檢定。本研究結果發現兩組運動組的肩屈肌和內旋肌的肌肉力量有明顯的進步。在綜合組的力量控制在運動介入前和介入十二週後之間也有明顯的進步。基於本研究結果，PNF與肌腱滑動運動可預期對上肢肌肉力量及感覺動作功能有正向的影響。但本研究小樣本數的限制可能會對研究結果的信度有巨大的影響。從結果而言，PNF及肌腱滑動運動對於上肢功能的療效是可被肯定的，也希望臨床醫療人員及糖尿病患者可從本研究有所獲益。

Upper limb functions of type 2 diabetes have been shown impaired; conversely, functions in prediabetes were less investigated in related studies. Reduced muscle mass has been found in the subject with the hyperglycemic level which is lower than the criteria of prediabetes. Despite some studies show that glycemic control might be correlated to the upper limb functions and the muscle mass, the relationship between muscle mass and upper limb functions and to differentiate these parameters between diabetes and prediabetes are remain unclear. The purpose of the first part of this study (Chapter 2) is to understand the muscle mass and the upper limb functions in patients with diabetes and prediabetes. Twenty-seven participants were recruited and assigned to the control group, prediabetes group and diabetes group based on their HbA1c level. Muscle mass, sensibility, strength, dexterity and sensorimotor of upper limbs were assessed by corresponding assessment tools. Kruskal-Wallis analysis of variance by ranks and Mann-Whitney U test were used to compare the result differences among the three groups. Pearson’s and Spearman’s rank correlation coefficient were used to determining the associations among upper limb functions and muscle mass in the prediabetes and diabetes groups. Sensibility, dexterity and muscle strength in upper limbs appear to have obviously poor performance in the diabetes group than the prediabetes group. Besides that, muscle mass showed to be positively related to muscle strength, and muscle mass negatively linked to force control capability in hand in the hyperglycemic population. Diabetic complications that are related to glycemic control might be responsible for differentiating the groups of prediabetes and diabetes in their upper limb functions. Correlation between muscle mass and muscle strength is well known in previous studies, but the mechanism of bonding between muscle mass and force control ability in hyperglycemic participants was lack of evidential findings. Therefore, prevention and intervention related to the declining function of upper limbs in diabetes should be emphasized in the further study.
Exercise is shown as a good intervention for diabetic complications which are responsible to those upper limb impairments. For the development of long-term exercise habit, a home-based program seems to be a good option. Proprioceptive neuromuscular facilitation (PNF) exercise and tendon gliding exercise (TGE) has been found suitable to enhance sensory and motor functions. However, the studies investigated the effect of these exercises in upper limbs of the diabetes population are still scant. The purpose of the second part of this study (Chapter 3) is to examine the effect of home-based PNF exercise and TGE on upper limb function in patients with type 2 diabetes. Three, four and three participants with diabetes were randomly assigned to the control group, the PNF group, and the mixed group respectively in this preliminary experiment. The PNF group completed a 12-week PNF exercise program, and the mixed group completed a 12-week PNF conjunction with TGE program. The exercise group performed 3 sets of 10 repetitions specific moves, 2 times per day, 3 days per week for 12 weeks of exercise programs. Assessments of upper limb functions were conducted at baseline, 12-week follow-up and 24-week follow-up time-points. Nerve conduction study, sensibility, strength, dexterity and sensorimotor of upper limbs were assessed using the corresponding regular and specific assessments. Friedman two-way analysis of variance by ranks with the Wilcoxon signed-rank tests for post hoc testing was used to compare the result differences among assessment results of upper limb functions in one group. The muscle strength of shoulder flexor and internal rotator showed obvious improvement in both exercise groups. In addition, force control capability which defined as sensorimotor function shows an obvious increase in the mixed group between baseline and 12-week. Based on this finding, the PNF and TGE programs were supposed to have positive effects on muscle strength and sensorimotor performance. Limitation in small sample size in this study might have a fatal influence on the reliability of results. However, the effect of PNF and TGE program in upper limb functions is promised in this study, and hopefully, clinicians and patients with diabetes can profit by this finding.

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