行为转变阶段模式下的健康管理对糖尿病合并肥胖症患者的影响

Effect of health management under the transtheoretical model and stages of change on diabetes mellitus patients with obesity

目的:研究行为转变阶段模式下的健康管理对合并肥胖症的糖尿病患者的影响。方法:将2019年1月至2020年6月广东省第二人民医院2型糖尿病(T2DM)合并肥胖症患者122例随机均分为观察组和对照组各61例,两组均常规药物治疗基础上进行个体化健康管理,对照组给予常规健康宣教和心理支持,观察组患者采用行为转变阶段模式进行干预,时间均为6个月,采用独立样本t检验比较两组干预后血糖、体重和患者自我效能等指标,采用χ^(2)检验或Fisher精确检验比较两组干预后行为习惯达标率。结果:两组干预6个月时FBG分别为(6.27±0.92)mmol/L和(6.58±0.91)mmol/L,2hPG分别为(8.53±1.39)mmol/L和(8.53±1.39)mmol/L,HbA1c分别为(6.49±0.91)%和(6.78±0.96)%,较干预前均明显降低(P<0.05),且两组间各指标比较差异无统计学意义;干预6个月时观察组BMI为(30.46±2.51)kg/m^( 2),腰围为(91.72±10.45)cm,体脂率为(34.09±3.84)%,较干预前均明显降低(P<0.05),且观察组BMI和体脂率低于对照组;两组一般自我效能量表(GSES)评分分别为(31.62±2.59)分和(28.75±2.48)分,较干预前均明显升高(P<0.05),且观察组GSES评分高于对照组;两组干预6个月时饮食控制达标率分别为92.98%和77.97%,合理运动达标率分别为87.72%和71.19%,坚持服药达标率分别为98.25%和91.53%,戒除烟酒达标率分别为94.74%和81.36%,血糖监测达标率分别为91.23%和94.92%,定期复查达标率分别为100%和98.31%,较干预前均明显升高(P<0.05),且观察组饮食控制、合理运动和戒除烟酒达标率高于对照组。结论:行为转变阶段模式用于糖尿病合并肥胖症患者自我管理干预有利于增强患者自我效能并改善患者行为习惯,有利于提升体重控制效果。

Objective To study the effect of health management based on the transtheoretical model and stages of change on patients with diabetes mellitus complicated by obesity.Methods A total of 122 patients with type 2 diabetes mellitus(T2DM)complicated by obesity and admitted to Guangdong Second Provincial General Hospital between January 2019 and June 2020 were recruited to participate in the study.They were divided into two equal groups at random,the observation group and the control group—with 61 patients in each group.Both groups were subjected to individualized health management based on conventional drug treatment.The control group received routine health education and psychological support,while the observation group was subjected to the transtheoretical model and stages of change interventions for six months.The independent-samples t-test was used to compare blood glucose,body weight,and self-efficacy in the two groups after interventions,and theχ^(2) test or Fisher′s precise test was used to compare behavior habit compliance rates in the two groups after interventions.Results FBG with(6.27±0.92)mmol/L and(6.58±0.91)mmol/L,2hPG with(8.53±1.39)mmol/L and(8.53±1.39)mmol/L,and HbA1c with(6.49±0.91)% and(6.78±0.96)% in the two groups were significantly lower at six months of interventions than those before(P<0.05),but the differences between the two groups were not statistically significant(P>0.05).BMI,waist circumference,and body fat rate with(30.46±2.51)kg/m^( 2),(91.72±10.45)cm,and(34.09±3.84)% of the observation group at six months of interventions were significantly lower than those before interventions(P<0.05),whereas there were no significant changes in the control group before and after interventions(P>0.05).The observation group′s BMI and body fat rate were lower than those of the control group(P<0.05).The General Self-Efficacy Scale(GSES)scores in the two groups were(31.62±2.59)points and(28.75±2.48)points,which were significantly higher than those before interventions(P<0.05).The observation group′s GSES score was higher than that of the control group(P<0.05).At six months of interventions,the compliance rates of diet control(92.98%and 77.97%),reasonable exercise(87.72%and 71.19%),adherence to medication(98.25%and 91.53%),quitting smoking and alcohol(94.74%and 81.36%),blood glucose monitoring(91.23%and 94.92%),and regular review(100.00%and 98.31%)were all significantly higher in the two groups than those before interventions(P<0.05).Additionally,the compliance rates of diet control,reasonable exercise,and quitting smoking and alcohol in the observation group were higher than those of the control group(P<0.05).Conclusion The use of the transtheoretical model and stages of change for the self-management intervention of diabetes mellitus patients with obesity is beneficial to improve self-efficacy,behavioral habits,and weight control effectiveness.