1型糖尿病结构性培训者的血糖控制及自我管理情况分析

Analysis of blood glucose control and self-management of participants with type 1 diabetes in structured training

目的探讨参加1型糖尿病(T1DM)夏令营结构性培训的患者血糖控制及自我管理情况。方法为横断面研究。选取2012年8月至2019年8月在中南大学湘雅二医院国家代谢性疾病临床医学研究中心确诊的全年龄段经典T1DM患者为研究对象,其中,自愿参加该中心每年1次康乐营活动(也称"夏令营")的T1DM患者纳入参加组,并根据倾向性评分方法选择性别、年龄(1∶2)匹配(卡钳值取0.03)的同时期在该中心诊断为T1DM且未参加过康乐营的患者作为未参加组。收集所有患者的血糖监测方式[血糖仪、瞬感扫描式葡萄糖监测系统(FGM)和(或)持续葡萄糖监测(CGM)]、每天自我血糖监测次数、目前胰岛素治疗方案、糖化血红蛋白(HbA1c),采用青少年T1DM自我管理量表(SMOD-A)(包括青少年与父母在糖尿病管理上的协作、糖尿病日常照护行为、与糖尿病相关问题的解决、与糖尿病相关的沟通和糖尿病管理目标5个分量表)和成人T1DM自我管理量表(SMOD-CA)(包括日常行为表现、疾病管理协作、疾病相关问题应对和疾病管理目标4个维度)评估患者自我管理水平。采用t检验、Mann-WhitneyU检验或χ^(2)检验进行组间比较。结果最终纳入参加康乐营T1DM患者299例,同时匹配527例未参加康乐营患者。与未参加组相比,参加组T1DM患者HbA1c达标率[分别为25.9%(131/505)和50.5%(139/275)]更高,使用FGM和(或)CGM[分别为15.4%(22/143)和48.5%(94/194)]、坚持每天自我血糖监测≥4次[分别为20.5%(30/146)和62.8%(125/199)]、采用胰岛素泵治疗[分别为16.2%(77/476)和24.2%(71/293)]的比例均更高(P<0.001)。此外,参加组的日常照护行为、相关问题的解决、糖尿病管理目标的掌握能力明显强于未参加组(P<0.05),但两组间在疾病管理协作方面的能力差异无统计学意义(P>0.05)。结论参加康乐营的T1DM患者HbA1c达标率总体较高。尽管自我管理的日常照护行为、相关问题的解决、糖尿病管理目标的能力掌握相较于未参加组较好,但是在疾病管理协作方面的能力仍然存在不足。

Objective To investigate the overall blood glucose control and self-management status of patients with type 1 diabetes(T1DM)in structured training who participated in a summer camp.Methods A cross-sectional study was conducted in patients of all ages diagnosed with type 1 diabetes mellitus(T1DM)at the National Clinical Research Center for Metabolic Diseases,Second Xiangya Hospital of Central South University from August 2012 to August 2019.The participating group included T1DM patients who voluntarily participated in an annual recreational camp activity("summer camp"),while the non-participating group consisted of T1DM patients diagnosed at the same time at the center who did not participate in the camp.According to the propensity scoring method,gender and age were included with a 1∶2 propensity score,and the caliper value was taken as 0.03.Data on blood glucose monitoring methods[glycaemic meters,flash glucose monitoring system(FGM),and/or continuous glucose monitoring(CGM)],frequency of daily self-glucose monitoring,current insulin treatment plan,and glycosylated hemoglobin(HbA 1c)levels were collected for all patients.The self-management level of patients was assessed using self-report measure of self-management of type 1 diabetes for adolescents(SMOD-A),which included five subscales related to cooperation between adolescents and parents in diabetes management,daily diabetes care behavior,problem-solving skills related to diabetes management,communication with others affected by diabetes,and goals for diabetes management;and self-management scale of type 1 diabetes for chinese adults(SMOD-CA),which included four dimensions related to daily behavioral performance,disease management cooperation,coping strategies for disease-related problems,and goals for disease management.Statistical analysis was performed using t-tests,Mann-Whitney U tests orχ^(2) tests for comparisons between groups.Results A total of 299 patients with T1DM who participated in a recreational camp were included,with an average age of 15.0(10.0,25.0)years and disease duration of 35.0(17.0,69.0)months.44.8%(134/299)were male.Five hundred and twenty-seven patients who did not participate in recreational camp were successfully matched by a 1∶2 comparative propensity score.Compared with the results of the non-participating group,the rate of HbA 1c reaching the standard in the participating group[25.9%(131/505)vs.50.5%(139/275)],use of FGM and/or CGM[15.4%(22/143)vs.48.5%(94/194)],adherence to daily self-glucose monitoring≥4 times[20.5%(30/146)vs.62.8%(125/199)],use of insulin pump therapy[16.2%(77/475)vs.24.2%(71/293)]were significantly higher,and the differences were statistically significant(P<0.05).In addition,the participation group were significantly higher than the non-participation group in daily care behaviors,solving related problems and grasping the ability to grasp diabetes management goals,with statistical significance(P<0.001),but there was no statistical significance in the ability to collaborate in disease management between the two groups(P>0.05).Conclusions The HbA 1c compliance rate of T1DM patients who participated in the leisure camp was generally higher.Although their daily care behaviors,problem-solving abilities,and mastery of diabetes management goals were better than those in the non-participating group,there were still shortcomings in disease management collaboration.