社区2型糖尿病老年患者个体化自我管理效果评估

Effect evaluation on individualized self-managemen of elderly type 2 diabetics in communities

【目的】评价个体化的自我管理对社区老年2型糖尿病患者稳定控制血糖的效果。【方法】2015年4月至2015年9月,在上海市奉贤区邬桥、西渡社区共计招募97例与家庭医生签约的门诊2型糖尿病患者纳入研究,研究对象随机分为两组,干预组49例,对照组48例。干预组:针对患者不同情况实施个体化的自我管理教育和病情评估,采用专家解疑、家庭医生服务团队上门及指导、强化家庭成员及糖友参与的综合模式;对照组:实施常规健康教育。两组病例随访6个月,前后均进行2型糖尿病患者自我管理行为量表(DSCA)生活运动方式的调查、血糖和糖化血红蛋白的检测,低血糖的发生率等。【结果】干预组:男28例,女21例;年龄(62.56±12.54)岁;对照组:男27例,女22例;年龄(62.02±11.73)岁;两组病人在年龄、性别、文化程度、病程和治疗方法等方面差异均无统计学意义(P>0.05)。干预前,二组在饮食、运动、用药行为,血糖监测、低血糖知识认知等各项指标较对照组差异均无统计学意义(P>0.05)。干预6个月后,干预组的健康行为得分:饮食(59.92±2.38)分、运动(33.44±3.29)分、用药行为(27.30±1.46)分,血糖监测(29.22±2.85)分、低血糖知识认知(24.12±1.72)分;血糖检测指标:空腹血糖(5.52±0.73)mmol/L、餐后2 h血糖(8.14±1.73)mmol/L及糖化血红蛋白(6.76±0.62)%,较对照组有明显改善(P<0.001)。干预6个月后,干预组健康行为得分、血糖指标的改变值均高于对照组,差异有统计学意义(P<0.001)。干预组低血糖的发生率较对照组明显下降,差异有统计学意义(P<0.001)。【结论】开展个体化的自我管理能获得更好的血糖控制,降低老年糖尿病患者低血糖的发生率。

[Objective] To evaluate the effect of individualized self-management for stable control of blood glucose among elderly diabetes patients in communities. [Methods] From April to September in 2015,a total of 97 patients with type 2 diabetes signed serving contract with family physician in Wuqiao and Xidu Community health service centers of Fengxian District in Shanghai were separated randomly by Diabetes Self-care Activities（ DSCA） into two groups,intervention group（ n = 49） and control group（ n = 48）.Intervention group： Education of individualized self-management and disease evaluation were performed on different patients. Comprehensive mode was used in this group including disambiguation of experts,doorto-door service and guidance of family doctor team and intensified participation of family members and friends with diabetes. Control group： Regular health education was carried out. The two groups were followed up for 6 months. Before and after investigation on the life style by Diabetes Self-care Activities（ DSCA） in patients with type 2 diabetes was performed,the same as detection of blood glucose and glycosylated hemoglobin,incidence of hypoglycemia etc. [Results] Intervention group： 28 males and 21 females with average age（ 62. 56 ± 12. 54） years old. Control group： 27 males and 22 females with average age（ 62. 02 ± 11. 73） years old. There were no significant differences between the two groups in age,gender,education level,course of disease and therapeutic method（ P〉0. 05）. Before intervention,there were no significant differences between the two groups in diet,exercise,drug taking behavior,blood glucose monitoring,hypoglycemia treatment and other indicators. After 6 month intervention,health behavior score of intervention group were as follows： diet（ 59. 92 ± 2. 38） points,exercise（ 33. 44 ±3. 29） points,medication behavior（ 27. 30 ± 1. 46） points,blood sugar monitoring（ 29. 22 ± 2. 85）points,hypoglycemia treatment（ 24. 12 ± 1. 72） points; blood glucose test： fasting plasma glucose（ 5. 52± 0. 73） mmol/L,postprandial 2 h glucose（ 8. 14 ± 1. 73） mmol/L and glycosylated hemoglobin（ 6. 76 ±0. 62） %,which were significantly improved comparing to the control group（ P〈0. 001）. After 6 month intervention,the scores of healthy behaviors and blood glucose indexes of intervention group were all higher than those in control group. The difference was statistically significant（ P〈0. 001）. Incidence of hypoglycemia in the intervention group was significantly lower than that in the control group,and the difference was statistically significant（ P〈0. 001）. [Conclusion] Development of individualized selfmanagement can significantly obtain better glycemic control and reduce the incidence of hypoglycemia in elderly patients with diabetes.