同伴支持模式对2型糖尿病患者自我效能、自我管理及血糖控制的远期影响研究

Long-term Effect of Peer Support Model on the Self-efficacy, Self-management and Blood Glucose Control in Type 2 Diabetic Patients

目的探讨同伴支持模式对2型糖尿病患者自我效能、自我管理及血糖控制的远期影响。方法于2013年以北京市东城区南片(原崇文区)5个社区卫生服务中心为研究现场,选取确诊的2型糖尿病患者为研究对象,每个社区卫生服务中心选取1个对照组、1个干预组,每组人数为15人左右,最终纳入对照组80人,干预组74人。2013年在干预前、干预6个月分别对两组患者进行问卷调查,并在2016年进行3年期随访,对3个时间点的数据进行分析。结果最终完成随访的患者,干预组76人,对照组68人。两组患者药物治疗、血糖监测、足部护理、处理高低血糖、总效能得分的比较,差异有统计学意义(P<0.05);不同时间点饮食控制、规律运动、足部护理、处理高低血糖、总效能得分的比较,差异有统计学意义(P<0.05);干预方法和时间在饮食控制、药物治疗、血糖监测、足部护理、处理高低血糖、总效能得分,空腹血糖、糖化血红蛋白上存在交互作用(P<0.05)。干预6个月后,干预组饮食控制、药物治疗、血糖监测、足部护理、处理高低血糖、总效能得分高于对照组,空腹血糖、糖化血红蛋白低于对照组;干预36个月后,干预组药物治疗、足部护理得分高于对照组,差异有统计学意义(P<0.05)。干预6个月后、干预36个月后,干预组饮食运动控制的患者比例高于对照组,差异有统计学意义(P<0.05)。结论同伴支持模式对2型糖尿病患者血糖控制的短期效果优于远期效果,在提升药物治疗和足部护理的自我效能及饮食运动行为干预方面存在远期效果。

Objective To explore the long-term effect of peer support model on the self-efficacy,self-management and blood glucose control in patients with type 2 diabetes mellitus.Methods Diagnosed type 2 diabetes patients in five community health service centers in the south of Dongcheng district(formerly Chongwen District)in Beijing were selected as research objects.One intervention group and one control group were selected in each community health service center,and each group was comprised of about 15 patients.Finally,there were 80 patients in the control group and 74 patients in the intervention group.In 2013,all patients were surveyed before the intervention and 6 months after intervention,and a three-year follow-up was conducted in 2016.The data at three time points were analyzed.Results Finally,76 patients in the intervention group and 68 patients in the control group were involved in the three-year follow-up.There was significant difference between two groups in drug treatment,blood glucose monitoring,foot care,high/low blood glucose management,and total self-efficacy score(P<0.05),and diet control,regular exercise,foot care,high/low blood glucose management,and total self-efficacy score differed at different time points(P<0.05).Intervention methods and time points had interaction on diet control,drug treatment,blood glucose monitoring,foot care,high/low blood glucose management,total self-efficacy score,fasting blood glucose,and glycosylated hemoglobin(P<0.05).After 6 months of intervention,the diet control,drug treatment,blood glucose monitoring,foot care,high/low blood glucose management,and total self-efficacy score in intervention group were higher than those of control group.After 36 months of intervention,drug treatment and foot care in intervention group were higher than those of control group(P<0.05).After 6 and 36 months of intervention,the intervention group had a higher rate of diet control and exercise control than control group(P<0.05).Conclusion Peer support model has better short-term effect on blood glucose control of patients with type 2 diabetes mellitus,while it is superior to standardized management in improving self-efficacy of drug treatment and foot care,and diet and exercise intervention in short term.