配对血糖监测方案干预对糖尿病患者疾病自我管理能力的效果评价

Effect of paired blood glucose monitoring-based intervention on patients′ability of self-management of diabetes

目的探讨配对血糖监测方案对糖尿病患者疾病自我管理能力及血糖控制水平的影响。方法以2017年1月至2018年6月在北京大学第一医院糖尿病共同照护门诊规律就诊(频率为每3个月一次复诊)一年以上的患者为研究对象,进行干预前后分析。分别在患者初诊及随访1年后测定糖化血红蛋白(HbA1c)、身高、体质量,计算体质量指数(BMI),并使用《糖尿病自我管理行为量表6》评价其自我管理能力。于患者初诊时指导患者居家进行餐前餐后配对血糖监测,并依据监测结果适当调整饮食、运动等活动。于1年诊时,调查患者就诊前1个月平均每周实际配对血糖监测频次。采用Wilcoxon检验比较不同配对监测频次患者在自我管理能力评分各方面(饮食、运动、自我血糖监测、遵医嘱血糖监测、足部护理和用药)的差异。采用t检验比较不同配对监测频次组间BMI及HbA1c的差异。结果符合入选标准并完成数据收集及量表评估的患者共153例。1年诊就诊前1个月内,平均每周配对血糖监测<1次的患者86例为非配对监测组,配对血糖监测≥1次的患者67例为配对监测组。1年诊时,配对监测组与非配对监测组在饮食[7.00(5.00~7.00)分vs 5.00(3.00~7.00)分]、自我监测血糖[4.50(2.00~7.00)分vs 2.00(0.25~4.00)分]及遵医嘱血糖监测[5.00(2.00~7.00)分vs 2.00(0~3.75)分]方面比较得分均较高,差异均具有统计学意义(Z=-2.663,P=0.008;Z=-3.851,P<0.001;Z=-3.892,P<0.001);在运动、足部护理及用药方面得分比较,差异均无统计学意义(P均>0.05)。在初诊和1年诊时,非配对监测组和配对监测组BMI和HbA1c方面比较,差异均无统计学意义(P均>0.05)。结论配对血糖监测方案有助于糖尿病患者依据血糖结果调整饮食,促进健康饮食行为,并提高其血糖监测依从性。

Objective To investigate the effect of intervention based on paired blood glucose monitoring on patients′self-management ability and blood glucose control.Methods From January 2017 to June 2018,patients who regularly visited the diabetes common care outpatient department of Peking University Hospital for more than a year(the frequency was once every 3 months)were analyzed before and after intervention.Hemoglobin a1c(HbA1c),height,and weight were measured and body mass index(BMI)was calculated after the patients were initially diagnosed and followed for one year,and their self-management ability was evaluated using the diabetes self-management behavior scale 6.At the time of the patient′s initial diagnosis,the patient was instructed to carry out paired blood glucose monitoring before and after meals at home,and the patient′s diet,exercise,and other activities were appropriately adjusted according to the monitoring results.At the time of diagnosis for one year,the average frequency of actual matched blood glucose monitoring per week in the month before the patient′s visit was investigated.The Wilcoxon test was used to compare the effects of different paired monitoring frequencies on patients′diet,exercise,self-measured blood glucose,compliance to doctor′s advice of monitoring,foot care,and medication.The t-test was used to compare the difference of BMI and HbA1c between different paired monitoring frequency groups.Results A total of 153 patients met the inclusion criteria and completed data collection and scale evaluation.In the first month before 1 year of diagnosis,86 patients who had a paired blood glucose monitoring frequency less than once a week on average were included in a non-paired blood glucose monitoring group,and 67 patients who had a paired blood glucose monitoring frequency equal to or more than once a week were included in a paired blood glucose monitoring group.After 1 year,the scores of diet[7.00(5.00-7.00)vs 5.00(3.00-7.00)],self-measured blood glucose[4.50(2.00-7.00)vs 2.00(0.25-4.00)],and compliance to doctor′s advice of monitoring[5.00(2.00-7.00)vs 2.00(0-3.75)]in the paired group were significantly higher than those in the non-paired group(Z=-2.663,P=0.008;Z=-3.851,P<0.001;Z=-3.892,P<0.001).At initial diagnosis and one year after diagnosis,there were no significant differences in sports,foot care,or medication score(P>0.05).There was no significant difference in BMI or HbA1c between the two groups(P>0.05).Conclusion Intervention based on paired blood glucose monitoring is helpful for diabetes patients to adjust diet according to blood glucose results,promote healthy eating behavior,and improve their compliance to hyperglycemia monitoring.