糖尿病肾病早期防治相关知识、态度和行为现况分析

Analysis on the knowledge,attitude and behavior of diabetes nephropathy related early control and prevention in four cities in China

目的了解来自不同医疗机构的医务人员和糖尿病患者预防糖尿病肾病(DN)知识、态度和行为现况,为DN的早期防控提供依据。方法在杭州、重庆、济南和武汉市7家综合医院和4家社区卫生服务中心的糖尿病相关门诊,分别针对2型糖尿病患者和医护人员,采用问卷调查询问DN相关知识、态度和行为。结果 1 207例糖尿病患者中,各种DN相关知识的知晓率为11.43%～89.15%,糖化血红蛋白(HbA1c)、尿微量白蛋白和胰岛素不具有成瘾性的知晓率最低,分别为11.43%、21.79%和34.63%。每年至少检测1次HbA1c和尿微量白蛋白的患者为14.41%和23.53%。极少患者定期复查血压、血脂、HbA1c和尿微量白蛋白四项指标均好的比例不足1%,仅1/4的患者认为医护人员曾建议其需定期检测HbA1c和尿微量蛋白。184名被调查医护人员中,各种DN相关知识的知晓率为48.91%～100.00%,其中,近一半医护人员未能正确掌握DN早期防治措施,综合医院组和社区组有相当比例的医护人员不能正确回答糖尿病诊断标准(分别为30.22%和55.56%)。结论不同医疗机构医患人群对于DN早期防治的认知水平普遍偏低,有必要进一步规范医护人员临床预防性诊疗服务,加强患者教育和自我管理能力。

Objective To investigate the knowledge,attitude and behavior of both medical workers and patients on the diabetes nephropathy（DN） related early prevention and control in hospitals and communities in order to provide evidence for the further healthcare service.Methods DM patients,doctors and nurses from 7 hospitals and 4 community health service centers in Hangzhou,Chongqing,Jinan and Wuhan were recruited.Questionnaire surveys were used to collect the KAP information of DN.Results Of 1207 objectives of DM patients enrolled,the total awareness of DN-related knowledge was 11.43%-89.15%.The proportion of patients who has the knowledge about HbA1c,microalbuminuria（MAU）and no addiction of insulin are 11.43%,21.79% and 34.63% respectively.During the past year,14.41% participants had an HbA1c test,23.53% had a MAU test.Only 0.68% participants had well-practice with all the four tests,including BP measure,HbA1c test,MAU test and cholesterol test.Preventive test was seriously low comparing with national guidelines and the gap was vast.Of 184 recruited doctors and nurses,the proportion of health care providers who have no idea about the diabetes diagnosis standard in the investigated hospitals or community was 30.22% and 55.56% respectively.Conclusions Participants of both patients and healthcare workers have poor knowledge about DN related early prevention and control in hospitals and communities.It is necessary to improve health care services of health workers,reinforce diabetic education and promotion to patients,and provide supports for patient self-management.