跨理论模式干预对老年2型糖尿病患者饮食控制依从性的影响研究

Effect of Transtheoretical Model on Diet Control Compliance of the Elderly with Type 2 Diabetes

目的探讨跨理论模式干预对老年2型糖尿病(T2DM)患者饮食控制依从性的影响,为发展和完善糖尿病健康教育计划提供实践依据及实施方法。方法选取2014年3—9月在南通大学附属医院内分泌科住院治疗的老年T2DM患者159例,根据就诊的先后顺序进行编号排序,奇数进入干预组(n=80),偶数进入对照组(n=79),患者均不知晓其所在的组别。干预前对所有患者建立档案,并进行饮食控制依从性问卷调查。对照组采用传统教育方式,参加科室专题讲座;干预组在对照组的基础上,运用跨理论模式,根据患者所处的饮食控制行为改变阶段,针对饮食控制方面问题进行一对一个体化干预。出院后两组均给予电话随访,1次/月,连续6个月。比较两组干预前后糖尿病饮食控制依从性、饮食控制行为改变阶段及临床指标。结果两组干预前饮食控制知识、饮食疗法依从性得分间差异均无统计学意义(P>0.05);两组干预后饮食控制知识、饮食疗法依从性得分间差异均有统计学意义(P<0.05)。两组干预前饮食控制行为改变阶段间差异无统计学意义(P>0.05);两组干预后饮食控制行为改变阶段间差异有统计学意义(P<0.05)。两组干预前BMI、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)间差异无统计学意义(P>0.05);两组干预后BMI、SBP、FPG、2 h PG、Hb A1c、TG间差异有统计学意义(P<0.05),而DBP、TC、HDL、LDL间差异无统计学意义(P>0.05)。结论跨理论模式健康教育在改善老年T2DM患者饮食控制依从性、饮食控制行为改变阶段及临床指标方面,效果优于传统教育,是科学、可行、有效的。

Objective To investigate the effect of transtheoretical model on diet control compliance of the elderly with type 2 diabetes（ T2DM）,and to provide the practical basis and implementation method for the development and improvement of diabetic health education plan. Methods 159 hospitalized T2 DM patients in Department of Endocrinology,Affiliated Hospital of Nantong University from March to September in 2014 were selected,and numbering them according to their order of receiving treatment,the ones with odd number were divided into intervention group（ n = 80）,and those with even number in the control group（ n = 79）,and the patients were not aware of the group in which they were located. Before the intervention,constructing archives and performing the questionnaire of diet control compliance for all the patients. Patients in the control group applied the traditional education mode and participated in the departmental special topic lectures; based on that of the control group,with transtheoretical model,according to the behavioral changing stage of diet control that patients in,one- to- one individualizedintervention targeting at the problems of diet control was conducted. After discharging from hospital, both groups were given telephone follow- up,1 time / month,for 6 months. The diet control compliance,behavioral changing stages of diet control and clinical indicators of diabetes patients in the two groups before and after the intervention were compared. Results There was no significant difference in the scores of diet control knowledge and diet therapy compliance between the two groups before intervention（ P〈0. 05）; there were significant differences in scores of diet control knowledge and diet therapy compliance between two groups after intervention（ P〈0. 05）. There was no significant difference in the behavioral changing stages of diet control between the two groups before intervention（ P〈0. 05）; there was significant difference in the behavioral changing stages of diet control between the two groups after intervention（ P〈0. 05）. There was no significant difference in BMI,systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,fasting plasma glucose（ FPG）,2 h postprandial blood glucose（ 2 h PG）,glycosylated hemoglobin（ Hb A1c）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein（ HDL）,low density lipoprotein（ LDL）（ P〈0. 05）; there were significant differences in BMI,SBP,FPG,2 h PG,Hb A1 c,TG between two groups after intervention（ P〈0. 05）,while no significant difference was found in DBP,TC,HDL,and LDL（ P〈0. 05）.Conclusion The effect of transtheoretical model on improving diet control compliance,behavioral changing stages of diet control and clinical indicators of the elderly with T2 DM is superior to that of traditional education. It is a scientific,feasible and effective way.