2型糖尿病患者饮食决策辅助工具编制及应用研究

Development and application of a dietary decision aids for type 2 diabetes patients

目的编制2型糖尿病(type 2 diabetes mellitus,T2DM)患者饮食决策辅助工具,并评价其临床应用效果。方法基于T2DM饮食决策辅助工具最佳证据、渥太华决策支持框架、国内外T2DM患者饮食决策相关研究,形成T2DM患者饮食决策辅助工具初稿,并根据国际患者决策辅助工具要求通过专家会议、用户评估对工具初稿进行修订和完善。选取2022年4月—9月在湖南省某三级甲等医院内分泌科住院的62例T2DM患者为研究对象,按照入院顺序将其分入对照组(4月—6月入院,n=31)和试验组(7月—9月入院,n=31),对照组接受常规护理,试验组接受常规护理联合T2DM患者饮食决策辅助工具干预。分别于干预前、出院3个月后比较两组糖尿病饮食治疗依从性、决策冲突,以及客观指标[BMI、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)]水平。结果编制的T2DM患者饮食决策辅助工具由决策阶段评估、信息支持、利弊分析、支持系统、价值思考、决策制订倾向性和决策确认7个部分组成。最终对照组29例、试验组30例完成本研究。出院3个月后,试验组糖尿病饮食治疗依从性得分高于对照组(P<0.05);决策冲突总得分、FPG、HbA1c、LDL-C低于对照组(P<0.05)。结论T2DM患者饮食决策辅助工具的运用在一定程度上可以提高T2DM患者饮食治疗依从性,降低其决策冲突水平,改善其血糖与血脂水平。

Objective To develop a dietary decision aids tool for patients with type 2 diabetes mellitus(T2DM)and evaluate its clinical application effect.Methods Firstly,a draft of the dietary decision aids for T2DM patients was formed based on the best evidence of dietary decision-making support tools for T2DM,the Ottawa Decision Support Framework,and relevant research on dietary decision-making for T2DM patients home and abroad.Then,the draft was revised and improved through expert meetings and user evaluations in accordance with international patient decision aid standards.A total of 62 T2DM patients admitted to the endocrinology department of a Grade-A tertiary hospital in Hunan Province from April to September 2022 were selected as the participants.They were divided into a control group(admitted from April to June,n=31)and an experimental group(admitted from July to September,n=31)depending on their order of admission.The control group received routine care,while the experimental group received routine care combined with the dietary decision aids intervention.Indicators were compared between the two groups before the intervention and three months after discharge,including the compliance with diabetes diet therapy,decision-making conflict,and BMI,fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein(LDL-C),and high-density lipoprotein(HDL-C).Results The constructed dietary decision aids for T2DM patients mainly consisted of seven components:decision-making stage assessment,information support,pros and cons analysis,support system,value consideration,decision-making tendency,and decision confirmation.29 patients in the control group and 30 patients in the experimental group completed this study.The scores of diabetes diet control knowledge and compliance with diet therapy in the experimental group were higher than those in the control group(P<0.05)at three-month after discharge.The scores of decision-making conflict,FPG,HbA1c,and LDL-C were lower in the experimental group than in the control group(P<0.05).Conclusion The application of the dietary decision aids for T2DM patients can,to a certain extent,improve the compliance with diet therapy among T2DM patients,while reducing their decision-making conflict,blood glucose,and blood lipids.