远程血糖管理模式对妊娠期糖尿病患者血糖管理及妊娠结局的影响

Effect of remote blood glucose management mode on blood glucose management and pregnancy outcome in patients with gestational diabetes

目的比较远程血糖管理模式与常规门诊血糖管理模式对妊娠期糖尿病(gestational diabetes mellitus,GDM)患者的自我管理行为、血糖及妊娠结局的影响。方法选取2017年4月至2018年4月东莞康华医院90例GDM患者,采用随机数字表法分成两组,观察组通过慢病管家平台给予远程血糖管理模式,进行数据采集、分析及指导;对照组给予常规门诊血糖管理模式。分析不同模式对患者自我管理行为,血糖、糖化血红蛋白及围产期孕妇、新生儿并发症发生率的影响。通过Logistic回归模型分析自我管理行为中各因素对患者血糖情况的影响。结果采用远程血糖管理模式的观察组患者,血糖及糖化血红蛋白指标及自我管理行为均明显改善(P <0. 05)。观察组孕妇并发羊水过多、剖宫产率与巨大儿发生率显著低于对照组(P <0. 05)。血糖监测、用药管理、饮食管理、运动管理、足部护理、健康教育与血糖控制达标存在显著相关性(P <0. 05),其中饮食管理是血糖达标的最关键保护性因素。结论对GDM患者采取远程血糖管理模式,实施"互联网+医疗健康"慢病管理的新型模式,能够加强患者自我管理行为,有效保持血糖水平稳定,降低母婴并发症发生率。

Objective To compare the effects of remote blood glucose management mode and routine outpatient blood glucose management mode on self-management behavior,blood glucose and pregnancy outcome in patients with gestational diabetes mellitus( GDM). Methods Ninety patients with GDM were enrolled in Dongguan Kanghua Hospital from April 2017 to April 2018. The patients were divided into two groups by random number table method. The research group gave remote blood glucose management mode through the chronic disease housekeeper platform for data collection,analysis and guidance. The control group gave routine outpatient blood glucose management mode. The effects of different modes on patient self-management behavior,blood glucose,glycosylated hemoglobin and perinatal pregnant women,and the probability of neonatal complications were analyzed. Logistic regression model was used to analyze the effects of various factors in self-management behavior on patients ' blood glucose status. Results In the observation group patients with remote blood glucose management mode,blood glucose and glycosylated hemoglobin index and self-management behavior were significantly improved( P<0. 05). The probability of polyhydramnios,cesarean section and macrosomia in the observation group were significantly lower than those in the control group( P<0. 05). There were significant correlation between blood glucose monitoring,medication management,diet management,exercise management,foot care,health education and blood glucose control( P<0. 05). Diet management was the most important protective factor for blood glucose compliance. Conclusion The remote blood glucose management mode for GDM patients and the implementation of the new model of "Internet + medical health"chronic disease management can strengthen patients' self-management behavior,effectively maintain stable blood sugar levels and reduce the incidence of maternal and child complications.