中国2型糖尿病患者饮食自我管理现状分析及对策

Current situation of diet self-management in patients with type 2 diabetes： a multi-centre survey in China

目的 调查我国2型糖尿病患者饮食认知及依从性现状.方法 采用面对面问卷调查我国29个省、直辖市的50个研究中心、144家二、三级和社区医院门诊及住院的确诊2型糖尿病1年以上的患者6043例.使用糖尿病态度量表、知识问卷和自护行为量表评价饮食自我管理情况.组间数据比较采用t检验.结果 （1）共同收5961份有效问卷.平均年龄（60±12）岁;体质指数（BMI）正常者占44.04％,超重或肥胖者占52.21％.3480例患者检测糖化血红蛋白（HbA1c）,达标率32.10％.（2）认知：接受过糖尿病饮食教育者4333例（72.69％）;饮食态度（3.7±1.0）分;食物对血糖的影响答题全部正确率1.85％（110/5961）,食物的描述答题全部正确率为0.52％（31/5961）;胰岛素治疗时饮食知识答题全部正确率为7.03％（258/3669）.（3）依从性：自护行为量表中普通饮食（4.9±2.2）分,特殊饮食（4.2±1.5）分;遵循饮食控制方案者4996例（83.81％）.（4） logistic回归分析显示,性别、年龄、文化程度、BMI、饮酒、接受过饮食教育、定期到医院复查糖尿病、定期自我监测血糖是影响2型糖尿病患者遵循饮食控制的因素.结论 我国2型糖尿病患者BMI偏高和HbA1c达标率低,饮食认知水平较差,女性、年龄越大、文化程度越高、BMI正常、不饮酒、接受过饮食教育、定期复查及自我监测血糖者遵循饮食控制情况较好.

Objective To research the current situation of diabetes diet cognition and compliance in patients with type 2diabetes in China.Methods This questionnaire-based survey was conducted in 50 medical centers in China from April to July in 2010.The selected medical centers covered 21 provinces,4 municipalities,4 autonomous regions,and the patients were out-patients and in-patients of 144 secondary,tertiary and community hospitals,the subjects had been diagnosed of type 2 diabetes for more than 1 year.The information of diabetes diet and management was collected by questionnaires.The diabetes attitude scale-3 （DAS-3） formulae,a questionnaire of diabetes knowledge,and summary of diabetes self-care activities （SDSCA） scale were used to assess diabetes diet cognition and compliance of patients.Comparison of data between groups was applied by using t test.Results Total of 6043 patients were eligible for the study,and 5961 valid questionnaires were collected.There were 3233 males and 2728 females with an average age of （60 ± 12） years（16-94 years） and a diabetes duration of （9 ±7） years.The mean body mass index （BMI） 44.04％ were normal and 52.21％ were overweight or obese.The glycated hemoglobin A1c （HbA1c） was examined in 3048 cases and 32.10％ of them reached the standard of ＜ 7％.Cognition：4333（72.69％） cases received diabetic diet education; the average of diet attitudes score was 3.7 ± 1.0; all correct answer rate of the impact of food on glycemia was 1.85％ （110/5961）,all correct answer rate of the description of food was 0.52％ （31/5961） ; 3669 （61.55％） cases treated with insulin,all correct answer rate of diet knowledge was 7.03％ （258/3669）.Compliance：the average of ordinary diet score was 4.9 ± 2.2 and the average of special diet score was 4.2 ± 1.5 in the SDSCA scale.Total of 4996 cases （83.81％） kept obeying the diet therapy program.And the gender,age,the level of education,BMI,drinking,receive diabetes education,regular follow-up,self-monitoring of blood glucose could influence the patient＇s compliance with diet therapy.Conclusions The mean BMI is high,the rate of HbA1 c ＜ 7％ and the level of diet cognition is low in Chinese patients with type 2 diabetes.And patient educators should consider the factors in diabetic health education,such as gender,age,the level of education,BMI,drinking,receiving diabetes education,regular follow-up,self-monitoring of blood glucose.