成人1型糖尿病患者自我管理水平和膳食模式的相关性研究

Investigation on relationship between self-management and diet pattern in adults with type 1 diabetes

目的应用中文版成人1型糖尿病(T1DM)自我管理量表(C-SDSCA)和简化版食物频率问卷对成人T1DM患者进行调查,分析自我管理水平和膳食模式的相关性。方法本研究于2018年4至10月,从广东省T1DM转化医学研究队列中招募100例成人T1DM患者进行C-SDSCA及食物频率问卷调查。按C-SDSCA得分指标将患者分为行为良好、中等、差三组,按食物频率问卷评估的膳食模式分为合理与不合理两组。不同分组间样本均数的比较采用t检验或方差分析(ANOVA),率的比较采用χ^2检验。采用多因素Logistic回归模型分析自我管理行为对膳食模式的影响。结果共回收问卷各100份,其中纳入合格问卷各93份进行统计。自我管理方面,患者平均得分指标仅为59%。膳食模式方面,患者膳食模式合理者仅占25.8%(24/93);膳食模式不合理组糖化血红蛋白较合理组明显升高[(7.4±1.1)%比(6.9±1.0)%,t=-2.08,P=0.04]。在膳食模式合理组,患者自我管理总分45.63±11.71,不合理组仅为35.03±11.73(t=3.81,P<0.01);在自我管理行为良好组,55.6%(10/18)的患者膳食模式合理,行为中等组22.0%(13/59),而行为差组仅为6.2%(1/16)(P<0.01)。多因素Logistic回归分析结果显示,自我管理行为分级每降低一个等级,膳食模式不合理的风险则增加4.78倍(OR=4.78,95%CI 1.71~13.34,P<0.01)。结论目前成人T1DM患者自我管理行为、膳食模式情况均不理想。T1DM患者膳食模式合理与否与血糖控制、患者自我管理水平相关,提示自我管理行为较差的患者需进一步加强饮食教育。

Objective To investigate the relationship between self-management and dietary pattern among adults patients with type 1 diabetes mellitus (T1DM) by a Chinese version of the Summary of Diabetes Self-Care Activities Measure scale (C-SDSCA) and a short food frequency questionnaire (FFQ). Methods C-SDSCA scale and FFQ were performed on 100 adult T1DM patients recruited from Guangdong T1DM Translational Medicine Study from April to October in 2018. According to the score of C-SDSCA scale, patients were divided into three groups by self-management: excellent, moderate and poor behaviors. Dietary pattern of the participants was classified as appropriate/inappropriate based on the results of FFQ. Differences between groups were comparedusing t-test,ANOVA test or chi-square test, when applicable. The effect of self-management behavior on dietary pattern was analyzed using multivariate logistic regression model. Results In total, 100 patients responded and 93 provided eligible responses. The average score of C-SDSCA scale was 59%, while only 25.8%(24/93) of the subjects had appropriate dietary patterns. Compared with patients with appropriate dietary patterns, those with in appropriate ones had significantly elevated level of HbA1c [(7.4±1.1)% vs (6.9±1.0)%, t=-2.08,P=0.04]. The scores of C-SDSCA were higher in the group of patients with appropriate diet patterns comparing to those with inappropriate ones (45.63±11.71 vs 35.03±11.73,t=3.81,P<0.01). In the group of excellent self-management behaviors,55.6%(10/18) patients had appropriate dietary patterns,but the ratio were only 22.0%(13/59) and 6.2%(1/16) in the groups with moderate and poor self-management behaviors,respectively. Results from logistic regression shows that deterioration in self-management level by one category was associated with a 4.78-fold increase in the risk of inappropriate dietary pattern (OR=4.78, 95%CI 1.71-13.34, P<0.01). Conclusions Current situation of self-managing behaviors and dietary patterns of adult patients with T1DM were not ideal. It was found that appropriate dietary pattern was associated with better glycemic control and better self-managing behaviors, indicating that more attention should be paid to diet education in patients who have poorer self-management behaviors.