以笔记本为工具的“PDCA循环”模式对社区中老年糖尿病患者饮食干预的效果

The effect of the“CDPA cycle”mode with a notebook as a tool in the intervention of the eating habits of middle-aged and elderly diabetic patients in the community

目的:探索以自行设计的笔记本为工具、以“PDCA循环”理论为基础的饮食干预对社区中老年2型糖尿病患者的影响。方法:收集2018年7-12月上海徐汇区枫林街道社区卫生服务中心家庭医生签约在管的272例2型糖尿病患者的信息,随机分为试验组和对照组各136例。因随访脱落等原因,最终试验组有118例,其中男性55例,女性63例,平均年龄为(58.91±3.24)岁;对照组有124例,其中男性56例,女性68例,平均年龄为(57.96±3.67)岁。试验组以自行设计的涉及患者个人基本信息的笔记本内容为基础,结合每1~2个月固定1次的患者集中活动,以“PDCA循环”模式对患者的不良饮食习惯进行干预。对照组则采用传统的门诊、家访、电话形式干预。两组干预均为18个月,评估干预前后两组的血糖和血脂等指标。结果:干预后试验组及对照组的腰臀比、体重指数、糖化血红蛋白、空腹血糖水平、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-c)都低于干预前,高密度脂蛋白胆固醇水平均高于干预前,差异均有统计学意义(P<0.05)。但干预后试验组的TC和LDL-c水平低于与对照组,差异均有统计学意义(P<0.05)。结论:以笔记本为工具的“CDPA循环”模式饮食干预改善血脂的效果优于传统随访方式。

Objective:To explore the effect of self-designed notebook as a tool,based on the theory of“CDPA cycle”to intervene the eating habits of middle-aged and elderly patients with type 2 diabetes in the community.Methods:Two hundred and seventy-two confirmed type 2 diabetes patients contracted by family doctors in Fenglin Community Health Service Center,Xuhui District,Shanghai from July to December 2018 were collected and randomly divided into an experimental group and a control group with 136 cases each.Due to the lost in the follow up,the experimental group completed 118 cases,of which 55 were males and 63 were females,with average age of(58.91±3.24)years.While the control group completed 124 cases of which 56 were males and 68 were females,with average age of(57.96±3.67)years..The experimental group was based on the selfdesigned notebook content involving the basic personal information of the patients,combined with the concentrated activities of the patients once a month or two months,and intervened the bad eating habits exposed by the patients in the“CDPA cycle”mode;the control group was intervened by traditional outpatient,home visit and telephone;both groups were intervened for 18 months.The levels of blood glucose and serum lipids were evaluated before and after the intervention.Results:After intervention,the levels of fasting blood glucose and glycosylated hemoglobin as well as WHR,BMI,TC,LDL-c were lower than those before intervention.The level of HDL-c in two groups after intervention were higher than those before intervention(P<0.05).After intervention,the levels of TC and LDL-c in experiment group were lower than those in contro group.the difference was statistically significant(P<0.05).Conclusion:The intervention of the eating habits using“CDPA cycle”mode based on the notebooks as a tool is more effective than traditional follow-up methods.