军队离退休老干部糖尿病患者饮食自我管理现状调查及实施健康教育培训的效果

Dietary self-management in the retired veteran cadres with diabetes and evaluation of the effect of the health education

目的调查军队离退休老干部2型糖尿病(T2DM)患者的饮食自我管理状况,并对实施健康教育培训的效果进行评价。方法选取2014年8月至2018年2月在解放军总医院门诊部干部诊疗科就诊的T2DM患者1300例。所有患者均由专职护士全面评估病情并建立档案,按照以家庭为中心的护理理念进行健康教育指导,采用问卷调查法分别于接受教育前及教育后3个月复诊时对所有患者进行问卷调查。采用SPSS 13.0软件进行数据处理,依据数据类型,组间比较分别采用t检验或χ2检验。结果有效问卷1269份,回收率97.6%(1269/1300)。1269例调查对象中男性1042例,女性227例,年龄52~91(71.5±7.6)岁。与教育前相比,教育后会按医嘱计算热量者的比例(59.2%vs 38.4%)、会使用食品交换法进餐者的比例(66.9%vs 46.5%)、了解食品含糖量者的比例(79.6%vs 64.5%)、参加糖尿病教育者的比例(50.6%vs 29.0%)、了解糖尿病知识者的比例(67.3%vs 16.3%)及参加随诊者的比例(84.5%vs 74.7%)均显著增加(P<0.05)。与教育前相比,教育后患者的体质量指数[(22.98±3.72)vs(23.78±3.06)kg/m2]、收缩压[(133.90±14.44)vs(136.20±13.95)mm Hg,1 mm Hg=0.133 k Pa]、舒张压[(78.42±8.82)vs(80.23±7.90)mm Hg]、总胆固醇[(3.95±0.61)vs(4.19±0.48)mmol/L]、甘油三酯[(0.86±0.29)vs(0.93±0.31)mmol/L]、糖化血红蛋白[(7.02±2.77)%vs(7.38±2.94)%]和尿白蛋白/肌酐比值[(20.75±22.75)vs(25.39±24.29)]显著降低(P<0.05)。教育前后空腹血糖值差异无统计学意义(P>0.05),但教育后的餐后2小时血糖显著改善[(7.83±4.71)vs(8.40±4.37)mmol/L,P<0.05]。结论老年T2DM患者的饮食自我管理状况较差,有针对性开展完善饮食自我管理的健康教育可提高患者自身对糖尿病的适应能力。

Objective To investigate the dietary self-management of retired veteran cadres with type 2 diabetes mellitus （T2DM） and evaluate the effect of health education. Methods Chosen for the study were 1300 patients with T2DM attending the Outpatient Department for Senior Cadres of PLA General Hospital from August 2014 to February 2018. All the patients were assessed and documented by full-time nurses, and health education was offered to them with the concept of family-centered nursing. A questionnaire survey was conducted with all patients before and 3 months after education. SPSS statistics 13.0 was used for data analysis, and depending on data type, Student′s t-test or Chi-square test was used for comparison. Results Valid questionnaires were collected from 1269 patients （1024 male and 227 female） with a recovery rate of 97.6%, the ages ranging 52-91 （71.5±7.6）years. A significant increase was observed after education of the patients who would calculate calories according to doctor′s order （59.2% vs 38.4%）, who would use food exchange lists for meals （66.9% vs 46.5%）, who knew the sugar content of food （79.6% vs 64.5%）, who participated in diabetes education （50.6% vs 29.0%）, who knew about diabetes mellitus （67.3% vs 16.3%）, and who paid follow-up visits （84.5% vs 74.7%, P〈0.05）. A significant decline was observed after education in the average body mass index [（22.98±3.72）vs （23.78±3.06）kg/m^2], systolic blood pressure [（133.90±14.44） vs （136.20±13.95）mmHg, 1 mmHg=0.133 kPa], diastolic blood pressure [（78.42±8.82） vs （80.23±7.90）mmHg], total cholesterol [（3.95±0.61） vs （4.19±0.48）mmol/L], triglycerides[（0.86± 0.29） vs （0.93±0.31） mmol/L], glycated hemoglobin [（7.02±2.77）% vs （7.38±2.94）%] and urinary albumin/creatinine ratio [（20.75±22.75） vs （25.39±24.29）, P〈0.05]. There was no significant difference in fasting blood glucose before and after education, but 2-hour postprandial blood glucose was significantly improved after education [（7.83±4.71） vs （8.40±4.37）mmol/L,P〈0.05]. Conclusion The elderly patients with T2DM have poor dietary self-management, and targeted health education contri-butes to enhanced their adaptability to diabetes mellitus.