藏族糖尿病患者代谢功能改善与面对面教育的效应

Effect of face-to-face education on metabolic improvement in Tibetan diabetic patients

目的:观察面对面随访方式的糖尿病教育对藏族患者代谢功能改善的作用。方法:①选择2005-08/2006-08在西藏军区总医院心内科住院和门诊就诊的糖尿病患者113例。男69例,女44例;年龄48～71岁。纳入糖尿病患者均符合1999年世界卫生组织糖尿病诊断标准,且对检测项目知情同意;均为离解放军西藏军区总医院最近的娘热乡藏族糖尿病患者。②测量身高、体质量、收缩压、舒张压,计算体质量指数=体质量/身高2。采用日立7600型全自动生化分析仪测定血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平。采用TosohHLC-723GHbV型高压液相色谱仪测定糖化血红蛋白。③所有参试者得到一份本院编写的藏汉对照糖尿病教育手册,并在分组前统一讲解,以上大课的形式进行普及教育。根据每个患者不同情况,由内分泌专业医师给予不同处方,包括饮食、用药、生活方式调整。随后将患者随机分为教育组56例(男35例,女21例)和对照组57例(男34例,女23例)。对照组主要采用患者主动咨询(电话咨询或医院复查)和每一两个月一次普及教育的方式,但医生不采用面对面主动干预;教育组的干预方式除上述普及教育以外,每2周进行一次面对面、一对一随访,并及时调整处方。半年后比较两组的代谢指标差异。④计量和计数资料的差异比较分别采用方差分析和χ2检验。结果:藏族糖尿病患者113例均完成随访并进入结果分析。①组间比较:干预前两组体质量指数、收缩压、舒张压、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖基化血红蛋白比较,差异不明显(P>0.05)。教育半年后教育组的体质量指数、收缩压、舒张压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和糖化血红蛋白均明显低于对照组(t=2.0156～4.7592,P<0.05～0.01),高密度脂蛋白胆固醇明显高于对照组(t=3.8031,P<0.01),其中以糖基化血红蛋白差异最明显。②组内比较:教育组糖尿病教育半年后血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇和糖化血红蛋白均较干预前明显降低(t=1.9832～3.6446,P<0.05～0.01),高密度脂蛋白胆固醇较干预前升高(t=2.8219,P<0.01),教育干预前后体质量指数无明显变化(P>0.05)。对照组糖尿病教育半年后,体质量指数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和糖化血红蛋白、高密度脂蛋白胆固醇与教育前相近(P>0.05)。结论:藏族糖尿病患者采取面对面的随访方式进行糖尿病教育较一般形式的糖尿病教育更好的改善其代谢功能。

AIM： To observe the effect of face-to-face follow-up diabetic education on metabolic improvement in Tibetan patients. METHODS： （1）Totally 113 diabetes mellitus patients from in and out Department of Cardiology in General Hospital of Tibetan Military Area Command of Chinese PLA were selected from August 2005 to August 2006. There were 69 male patients and 44 female patients. The age ranged from 48 to 71 years. All the diabetes mellitus patients were recruited according to the 1999 WHO Diabetes Mellitus Diagnostic criteria. All participants accepted the examination items. Diabetic patients were screened in Niang-Re community of Lhasa city, where was very near to the General Hospital of Tibetan Military Area Command of Chinese PLA. （2）Height, body mass, systolic blood pressure, diastolic blood pressure were measured. Body mass index （BMI） was calculated as body mass/height^2. Serum total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were measured with Hitach 7600 Biochemistry Autoanalyst. Glycosylated hemoglobin was measured with Tosoh HLC-723 GHbV type Chromatography Analyst. （3） Diabetes mellitus educational manuals were given to all participants. Introduction and prevalence education were carried out among all participants. Intervention on diet, drug therapy and life-style adjustment were carried out in all patients under the supervision of endocrinology doctors according to the different condition of each subject. Patients were divided into Education Group （56 patients, with 35 males and 21 females） and Control Group （57 patients, with 34 males and 23 females） randomly. The follow-up in Control Group was mainly consultation by telephone and reexamination in hospital initiatively by patients and prevalence education once every one or two months, but not face-to-face follow-up by doctors. Face-to-face follow-up was done in Education Group every 2 weeks. Drug therapy was adjusted in time in Education Group. Metabolic parameters were measured half a year after intervention. （4）Analysis of variance was used to evaluate the measurement data, and Х^2 test for enumeration data. RESULTS： Totally 113 patients finished the follow-up and were enrolled in the result analysis. （1）comparison between groups： BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and glycosylated hemoglobin had no significant differences before intervention （P 〉 0.05）. But half a year after intervention, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol and glycosylated hemoglobin in Education Group were obviously lower than those in Control Group （t =2.015 6-4.759 2,P 〈 0.05-0.01）. High-density lipoprotein cholesterol was higher in Education Group than in Control Group （t = 3.803 1,P 〈 0.01）. Among all the parameters, glycosylated hemoglobin in the two groups differed mostly. （2）comparison within group： Total cholesterol, triglyceride, low-density lipoprotein cholesterol and glycosylated hemoglobin in Education Group were all much lower （t =1.983 2-3.644 6,P 〈 0.05-0.01）, but high-density lipoprotein cholesterol was higher （t =2.821 9, P 〈 0.01） after half a year intervention in Education Group. There was no significant change in BMI （P 〉 0.05）. But in Control Group, BMI, total cholesterol, triglyceride, low-density lipoprotein cholesterol and glycosylated hemoglobin, high-density lipoprotein cholesterol changed little before and after intervention （P 〉 0.05）. CONCLUSION： Face-to-face follow-up on metabolic improvement in Tibetan diabetic patients is more highly effective than general prevalence education.