社区管理的2型糖尿病患者慢性并发症监测行为及其影响因素研究

Prevalence and Associated Factors of Behaviors of Monitoring to Prevent Chronic Diabetic Complications among Type 2 Diabetes Patients Involved in Community-based Management

背景2型糖尿病慢性并发症发生率高,慢性并发症是糖尿病致残和致死的根本原因。尽早规律、持续地监测以早发现、早诊断和早治疗各类慢性并发症,是降低糖尿病不良后果的根本,也是社区糖尿病管理务必重视的内容。目的了解社区管理的2型糖尿病患者慢性并发症监测行为状况,分析糖尿病患病及监测相关情况与慢性并发症监测行为水平的关系。方法于2019年5—11月,采取方便抽样法,选取成都市中心城区参与社区2型糖尿病管理的785例患者作为研究对象,对其进行一般情况、糖尿病患病情况和慢性并发症监测行为问卷(自我观测和专项筛查)的调查。结果785例社区管理2型糖尿病中,103例(13.1%)没有罹患任何慢性并发症,435例(55.4%)同时罹患代谢综合征和糖尿病慢性并发症。患者慢性并发症自我观测行为总均分为(2.58±0.86)分,检查足背动脉搏动行为得分仅为(1.33±0.67)分;患者慢性并发症专项筛查行为总均分为(2.77±0.57)分,其中视网膜检查、周围神经病变检查、下肢血管病变检查行为得分分别为(1.88±0.99)、(1.46±0.84)、(1.47±0.84)分。614例(78.2%)患者在医生建议下进行专项筛查,主动定期筛查者仅有78例(9.9%);分别有139例(17.7%)和385例(49.0%)患者对自我观测异常和专项筛查结果不能采取正确的处理方式。多重线性回归分析结果显示,糖尿病确诊时间、慢性并发症罹患情况、对自我观测异常情况的处理是社区管理的2型糖尿病患者慢性并发症自我观测行为得分的影响因素(P<0.05),糖尿病确诊时间、最近一次检测糖化血红蛋白(HbA_(1c))水平、慢性并发症罹患情况、参加专项筛查的原因、对专项筛查结果的处理情况是社区管理的2型糖尿病患者慢性并发症专项筛查得分的影响因素(P<0.05)。结论社区2型糖尿病患者慢性并发症监测行为水平不高,且受患者糖尿病确诊时间、罹患慢性并发症情况、最近一次检测的HbA_(1c)水平、参加专项筛查的原因及对监测结果的处理方式影响。在社区管理中应根据患者的疾病相关情况积极调动患者的主观能动性,促进患者主动、规律地对慢性并发症进行自我观测和专项筛查,提高2型糖尿病患者慢性并发症早诊断与早治疗率。

Background Chronic diabetic complications are highly prevalent,which may be an underlying cause of diabetes-related disability and death.Regularly and continuously self-monitoring may contribute to early detection,diagnosis and treatment of various diabetic complications,which is essential to reducing the adverse consequences of diabetes,and is a key program in community-based management that should be highly valued.Objective To investigate the prevalence and associated factors(such as diabetes prevalence and monitoring and other factors)of behaviors of monitoring(self-observation and screening tests)to prevent chronic diabetic complications among type 2 diabetes patients receiving community-based management.Methods The convenience sampling was used to select 785 type 2 diabetes patients from Chengdu's central urban areas who received community-based type 2 diabetic management from May to November 2019.They were invited to attend a survey for understanding their socio-demographic information and monitoring behaviors to prevent chronic diabetic complications using a questionnaire developed by us.Results Only 103(13.1%)of the patients did not suffer from any chronic complications,and 435(55.4%)suffered from both metabolic syndrome and chronic diabetic complications.The average total score for self-observation of chronic diabetic complications in the participants was(2.58±0.86),but the average total score of regularly self-observation of pulsations of the dorsalis pedis artery was only(1.47±0.84).The average total score of performing screening tests for chronic diabetic complications was(2.77±0.57).The average score of diabetic retinopathy screening,peripheral neuropathy screening,and lower extremity vascular disease screening was(1.88±0.99),(1.46±0.84),and(1.47±0.84),respectively.About 78.2%(614/785)of patients underwent screening tests following the doctors'advices.But only 9.9%(78/785)took the initiative to conduct regular tests.About 17.7%(139/785)and 49.0%(385/785)of the patients could not correctly manage the abnormal results of self-observation and the screening test results.Multiple linear regression analysis indicated that the duration of diabetes since diagnosis,prevalence of chronic diabetic complications,and management of self-observed abnormalities were associated with the score of self-observation of chronic diabetic complications(P<0.05).The duration of diabetes since diagnosis,the most recently measured HbA_(1c) value,prevalence of chronic diabetic complications,causes and results management of screening tests for chronic diabetic complications were associated with average total score of performing screening tests for chronic diabetic complications(P<0.05).Conclusion The prevalence of behaviors of monitoring to prevent chronic diabetic complications in community-dwelling type 2 diabetes patients was unsatisfactory,which was affected by the duration of diabetes since diagnosis,prevalence of chronic diabetic complications,the most recently measured HbA_(1c) value,causes and results management of screening tests for chronic diabetic complications.In view of this,in the delivery of community-based management services,attentions should be paid to improving patients'initiative to actively and regularly observe their conditions and undergo relevant screening tests,thereby improving early diagnosis and treatment rates of chronic type 2 diabetic complications.