| 安凌王 陈琳慧 徐慧君 李洮俊 朱彩星 张陆平 李建平 丁晓 贾娇娇 白丽敏 孙秀芹 胡肇衡 纪立农.一项住院2 型糖尿病患者血糖控制、自我管理行为及心理评估的调查[J].,2015,15(32):6342-6351 |
| 一项住院2 型糖尿病患者血糖控制、自我管理行为及心理评估的调查 |
| Inpatients with Type 2 Diabetes: A Survey of Glycemic Control, Self-careBehavior and Psychological Status |
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| DOI： |
| 中文关键词: 糖尿病，2 型 教育管理 饮食 血糖监测 抑郁 |
| 英文关键词: Diabetes mellitus, Type 2 Education and management Diet Blood glucose monitoring Depression |
| 基金项目: |
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| 中文摘要: |
| 摘要目的：目前针对中国糖尿病教育管理现状的高质量调查仍然不是很多，因此我们对一家糖尿病专科医院的住院2 型糖尿患
者进行了问卷调查，收集其自我管理行为、血糖控制及抑郁与心理状况，以探讨糖尿病教育管理工作的重点。方法：对2014 年9
月至12 月间在太原糖尿病专科医院住院治疗的2 型糖尿病患者，进行面对面的问卷调查。调查问卷包括一般资料问卷、Toobert
行为量表简化版及WHO-5 幸福感指数量表(WHO-5Well-Being Index) 和中文版简化糖尿病问题量表(short-form Chinese-version
PAID [SFPAID-C] scale）。结果：共调查患者330 例，经双份录入和数据澄清之后剩余有效问卷315 份（95.5%），男性150（47.6 %）
例，女性165（52.4 %）例。患者年龄（60.5 ± 9.2）岁，病程（10.0 ± 7.1）年，BMI (25.3 ± 3.5) kg/m2、腰围(91.4 ± 9.9)厘米，糖化血红
蛋白(HbA1c) (8.5 ± 2.0) %，超重与肥胖的患者分别为71.8 %和88.5 %，男性和女性腹型肥胖的患病率分别为75.0 %和72.7 %，8
.6 %的患者存在亚临床或临床抑郁问题（SF-PAID-C评分≥ 15）。73.3 %的患者接受过糖尿病教育，86.0 %的患者定期监测血糖，过
去一年检测过HbA1c 和血脂的患者分别为66.7 %、62.9 %，87.3 %的患者在诊断糖尿病后改变了饮食习惯，61.9 %的患者定时定
量进餐，74.6 %的患者规律运动，66.7 %的患者每周运动时间≥ 150 分钟。Toobert 行为量表显示，患者在执行每天吃五份以上的
水果和蔬菜(2.5 ± 2.5)、把碳水化合物均匀分布到一整天(3.5 ± 2.8)、血糖监测(3.4 ± 2.5)以及检查脚和鞋子(3.7 ± 2.5)方面的天
数较少，执行天数为0 天的患者比例分别为36.0 %、25.8 %、13.3 %和16.5 %。将患者分为接受过(231 例, 75.2 %)和未接受过糖尿
病教育(76 例, 24.8 %)两组，接受过糖尿病教育者，年龄更大，病程更长，合并糖尿病视网膜病变、神经病变的百分比及胰岛素治疗
的百分比更高，自我管理行为更好，HbA1c 水平更低，但SF-PAID-C 评分和WHO-5 评分没有显著性差异。将患者根据病程分为
<5 年、6 - 10 年、11 - 15 年、≥ 16 年四组，随着病程增加，接受过糖尿病教育的患者比例增加，糖尿病并发症的患病率及胰岛素治
疗的百分比显著增加，WHO-5 评分下降，SF-PAID-C 评分上升，自我管理行为和HbA1c 差异不显著。回归分析显示，影响HbA1c
的因素包括治疗方案和自我管理行为，影响SF-PAID-C 评分的因素包括运动状况及是否合并糖尿病神经病变，影响WHO-5 评分
的因素包括病程和自我管理行为。结论：饮食、血糖监测、足部护理、社会支持及用药依从性方面的糖尿病教育指导需要更为细
致。糖尿病人在病程较长、合并有并发症及使用胰岛素治疗时，才有更大机会获得糖尿病教育，但将错过教育的最佳时机，糖尿病
教育的开始时间需更早。在提升幸福指数、改善抑郁和焦虑方面，糖尿病教育没有直接作用，改善疾病控制、坚持自我管理行为、
推迟并发症的发生发展，有直接作用。 |
| 英文摘要: |
| Objective:High quality investigation on the present diabetes education and management situation in China is still
relatively rare. A survey of questionnaire was made in type 2 diabetes inpatients in a diabetes hospital. Self-care behavior, blood glucose
control and psychological status were discussed to explore the key task of diabetes education and management.Methods: A face-to-face survey of questionnaire was made in type 2 diabetes inpatients in Taiyuan diabetes hospital fromSeptember 2014 to December 2014. The
questionnaire included general information, simplified version of Toobert behavior, WHO-5Well-Being Index and a short-form
Chinese-version PAID [SFPAID-C] scale. A total of 330 patients were surveyed, 315 (95.5 %) were enrolled into final analysis
after data entry and clarification. Among the 315 participants, 150 (47.6 %) were male, 165 (52.4 %) were female. The mean age was
(60.5 ± 9.2) years, duration was (10 ± 7.1) year, BMI was (25.3 ± 3.5) kg/m2, waist circumference was (91.4 ± 9.9 ) cm, HbA1c was
(8.5 ± 2) %. The percentage of overweight and obesity patients were 71.8 %and 88.5 %, the abdominal obesity prevalence were 75 %
and 72.7%among male and female. 8.6 %of the patients had subclinical or clinical depression (SF-PAID-C score ≥ 33), 73.3%of the
patients received diabetes education, 86 % of the patients regularly monitored blood glucose. 66.7% and 62.9% of the patients tested
HbA1c and blood lipids over the past year, 87.3 % of the patients changed their eating habits after diagnosis of diabetes, 61.9% of
patients regularly ate meals, 74.6 % of the patients regularly did exercise, more than 66.7 % of the patients did exercise at least 150
minutes /week. Toobert behavior scale displayed that the patients ate five or more (2.5 ± 2.5) servings of fruits and vegetables, spacing
carbohydrates evenly through the day (3.5 ± 2.8), testing blood glucose (3.4 ± 2.5) and inspecting feet and shoes (3.7 ± 2.5), the patients never executing those activities were 36.0 %, 25.8 %, 13.3% and 16.5 % separately. Among the patients, 76 ( 24.8 %) didn't
receive diabetes education and 231 (75.2 %) received diabetes education who were older, with longer duration, higher percentage of
insulin treatment, higher prevalence of diabetic retinopathy and neuropathy,better performance of self-care behavior, and lower level of
HbA1c; there was no significant difference in SF-PAID-C score and WHO-5 score between the two types of patients. The patients were
divided into 4 groups according duration (<5, 6-10, 11-15 and ≥ 16 years). With the increasing of diabetes duration, the proportion of
patients received diabetes education, the percentage of insulin treatment, and the prevalence of diabetic complications significantly
increased, but WHO-5 score decreased, SF-PAID-C score increased, without significant difference self-care behavior and HbA1c level.
Regression analysis showed that the factors affecting HbA1c were treatment regimen and self-care behavior, the factors affecting
SF-PAID-C score were exercise and diabetic neuropathy, the factors affecting WHO-5 were duration and self-care behavior.Results:Conclusion:More detailed diabetes education in the field of diet, blood glucose monitoring, foot care, social support and medication compliance are
needed. Diabetes education should be started in patients with diabetes as early as possible. Diabetes education has no direct effect in
improving the happiness index and depression and anxiety; while it has direct effect in improving diabetes control, adherence to the
self-management behavior, and delay of the complications. |
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