The Improving Effects of Diabetes Education on Diabetes Awareness and Management in Children and Adolescents with T1DM

Background: Diabetes education is crucial in empowering persons with Type 1 diabetes (T1DM) and their families to properly manage the condition by providing comprehensive knowledge, tools, and support. It boosts one’s belief in their ability to succeed, encourages following medical advice, and adds to the general enhancement of health. Objective: This study is to investigate the effectiveness of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively manage the condition. Furthermore, it strives to improve nursing care for families whose children have been diagnosed with Type 1 Diabetes Mellitus (T1DM). Design: This research study investigates the efficacy of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively handle the condition. Materials and Methods: A systematic search was conducted between the years 2000 and 2022, utilizing the Medline and Google Scholar databases. The purpose of the search was to uncover relevant papers pertaining to diabetes education, management of Type 1 Diabetes Mellitus (T1DM), nurse care, and empowerment. The search focused on peer-reviewed research, clinical trials, and scholarly articles that evaluated the efficacy of diabetes education in empowering individuals and families. Results: Diabetes education is crucial for understanding and controlling T1DM. It includes personalized sessions, webinars, group classes, and clinics that provide customized therapies. Comprehensive education enhances glycemic control and family dynamics. Nevertheless, the implementation of diabetes education for families requires specific standards, especially in the field of nursing. Conclusion: Diabetes education is essential for effectively managing Type 1 Diabetes Mellitus (T1DM), providing patients and families with crucial knowledge, resources, and confidence. It encourages independence in-home care and provides explicit guidelines for diabetic nurses to improve nursing care.

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration

Objectives: Treatment preferences affect treatment engagement, adherence and outcomes. There is limited knowledge of patients’ preferences for Diabetes Self-Management Education (DSME). This study explored the preferences of Canadians with diabetes for components, mode and dose for implementing DSME interventions. Methods: A cross-sectional design was used. Adults with diabetes completed a questionnaire to assess participants’ preferences for components (i.e. content), mode (i.e. teaching strategies, delivering formats) and dose (i.e. number and length of sessions) of DSME. Descriptive statistics were used to analyze the data. Results: Participants (n = 100) were middle-aged men and women, who had diabetes for 6.1 years and previously received (95.0%) DSME. They indicated preference for DSME to include a combination of educational, behavioral and psychological components;to be delivered in individual, face-to-face sessions (4 sessions, 60 minutes each, given monthly) that allowed discussion with one diabetes educator to develop and carry out a care plan. Conclusions: Diabetes educators may consider eliciting patient’s preferences and tailoring DSME to fit patients’ preferences. Delivering interventions that are consistent with patients’ preferences increases their motivation to engage in intervention, satisfaction and adherence to treatment and achievement of desired outcomes.

Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

WJD 5^(th) Anniversary Special Issues(2): Type 2 diabetes Structured SMBG in early management of T2DM: Contributions from the St Carlos study

Diabetes mellitus type 2(T2DM)is a global pandemic that will affect 300 million people in the next decade.It has been shown that early and aggressive treatment of T2DM from the onset decreases complications,and the patient’s active role is necessary to achieve better glycemic control.In order to achieve glycemic control targets,an active attitude in patients is needed,and selfmonitoring of blood glucose(SMBG)plays a significant role.Nowadays,SMBG has become an important component of modern therapy for diabetes mellitus,and is even more useful if it is performed in a structured way.SMBG aids physicians and patients to achieve a specific level of glycemic control and to prevent hypoglycemia.In addition,SMBG empowers patients to achieve nutritional and physical activity goals,and helps physicians to optimize the different hypoglycemic therapies as demonstrated in the St Carlos study.This article describes the different ways of using this educational and therapeutic tool from the medical point of view as well as from the patient’s perspective.

Influence of education training in patients with type 2 diabetes in the improvement of lifestyle and biochemical characteristics: a randomized controlled trial

Objective: The objective of this randomized controlled trial study was to evaluate the education training in relation to lifestyle improvement in patients with type 2 diabetes through its influence in the levels of glycated hemoglobin(HbA1 c), blood pressure, triglyceride, cholesterol levels, and body mass index(BMI).Methods: The study included patients with type 2 diabetes randomly selected from 20 residential areas in Tirana, Albania where family physicians provide services. The sample size in total was 200 patients in both groups(control and intervention). The education training(four sessions) was conducted by trained nursing staff for 6 months. Patients were screened for the biochemical profile before and after the intervention. To compare the groups with respect to the interest outcomes, the t-test was used. The value of P < 0.05 was considered significant.Results: There were 104 male patients and 96 female patients. The mean age was 54.9 ± 8.7. No significant differences were found between the study groups in relation to clinical and biochemical data before the education sessions. After the intervention, in the intervention group, the mean level of HbA1 c was significantly lower than the value in the control group(6.2% vs 6.8%, P = 0.001) as well as for the mean values of BMI. The mean reduction(more than 15%) in HbA1 c after the intervention was 43% in the intervention group and 2% in the control group(OR = 36.9, P < 0.05). Differences in BMI, HbA1 c, triglycerides, and cholesterol were more significantly visible in the intervention group. However, the difference in systolic and diastolic blood pressure values was almost the same(P > 0.05).Conclusions: The results of this study further support that the approach for education of patients with type 2 diabetes on changing lifestyle benefit the patient in controlling diabetes. It is believed that the establishment of diabetes education classes in health centers is an important investment in improving the management of type 2 diabetes.

Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes—The Active Ingredient in the Education. A Qualitative Study

Background: Diabetes self-management education (DSME) for patients with type 2 diabetes requires efficient teaching methods that make patients want to change lifestyle in terms of their diabetes. The study looks at what may be the active ingredient in this DSME. Objective: To explore how participants in DSME, with an interactive learning method, experienced changes in relation to diet and physical activity. Method: We studied possible changes in diet and physical activity by semi-structured individual interviews of 16 participants attending DSME. Results: Before the DSME, the participants felt insecure about what to eat, and they expressed little interest in changing their physical activity. Just after the DSME, they were more optimistic about diet because they had learned how to interpret food labels and compose their meals. Furthermore, they had experienced the benefit of physical activity in relation to their blood glucose levels. Behavior changes appeared to persist the following half year. We discuss the findings in light of the principles of interactive learning. The participants experienced an effect of their behavior changes, and blood glucose measurement was used as a tool to gain control and reach a state of well-being. Conclusion: From being insecure about what to eat, the patients acquired knowledge to handle their diet through the DSME. They learned how to compose their meals and use physical activity to regulate their blood glucose. We suggest that the interactive learning used in the DSME was an active ingredient that led to changes in behavior and should be considered as an educational method in DSME for patient with type 2 diabetes.

A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China

Background Diabetes management could be improved by diabetes education, through influencing attitudes towards diabetes, knowledge and behaviors of patients. The purpose of this study was to characterize the impact of diabetes education on glycemic control, and to assess the attitude, knowledge and self-care behavior in patients with type 2 diabetes in China. Methods This questionnaire-based survey was conducted in 50 medical centers across China from April to July of 2010. The patients with type 2 diabetes were eligible for the study. The information of glycemic control and diabetes education was collected. The diabetes attitude scale-3 formulae, a questionnaire of diabetes knowledge and Summary of Diabetes Self-care Activities scale were used to assess attitude, knowledge and the self-care of patients, respectively. Results Among the 5961 eligible respondents （3233 males; mean age （59.50＋12.48） years; mean hemoglobin Alc （HbAlc） （8.27＋2.23）%）, most patients （79.8%） considered themselves educated on diabetes. Compared with patients without diabetes education, their educated counterparts showed significant lower value of HbAlc, after controlling for age, gender, body mass index and duration of diabetes （P 〈0.01）. The patients who received diabetes education also performed significant higher scores on attitude, knowledge and self-care than their uneducated counterparts. Patients with lower income or education level tended to have higher glucose levels, and showed lower percentage of patients received diabetic education. Conclusions Chinese patients with diabetes education achieved better glycemic control than un-educated patients. Our study indicates effort is required to provide professional education to patients, with emphasis on lower income and lower education level populations.

Future technology-enabled care for diabetes and hyperglycemia in the hospital setting

Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging.Inpatient technology-enabled support systems are being designed,adapted and evaluated to meet this challenge.Insulin pump use,increasingly common in outpatients,has been shown to be safe among select inpatients.Dedicated pump protocols and provider training are needed to optimize pump use in the hospital.Continuous glucose monitoring(CGM)has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit(ICU)settings but data on cost effectiveness is lacking.CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns.Compared to unstructured insulin prescription,a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems.Relative efficacy and cost among these systems remains unanswered.An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital.These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.

儿童和青少年2型糖尿病患者饮食管理的最佳证据总结

目的检索、评价并整合国内外儿童和青少年2型糖尿病患者饮食管理的最佳证据,为临床护理提供参考。方法系统检索指南网站、专业协会网站和数据库中关于儿童和青少年2型糖尿病患者饮食管理的证据,包括临床决策、最佳实践、指南、专家共识、系统评价等,检索时限为2014年1月至2024年5月,由2名研究者对纳入文献进行方法学质量评价,对符合标准的文献进行资料提取和证据汇总。结果共纳入15篇文献,包括临床决策1篇,指南5篇,专家共识9篇。从管理目标、评估、体质量管理、营养素推荐、运动的饮食管理、团队合作与教育6个方面汇总38条最佳证据。结论本研究总结了儿童和青少年2型糖尿病患者饮食管理的最佳证据,可为护理人员开展临床实践提供参考。医护人员可以结合临床情景,个性化地应用相关证据,促进患者的科学管理。

多元化团体互动健康教育对糖尿病患者血糖达标率和自我管理能力的影响

目的探讨给予糖尿病患者多元化团体互动健康教育对其血糖达标率和自我管理能力的影响。方法研究样本均来自我院收治的糖尿病患者,共80例,按随机数表法分组,给予对照组(40例)常规护理+常规健康宣教,给予观察组(40例)常规护理+多元化团体互动健康教育,观察两组对疾病知识的知晓率、负性情绪、自我管理能力、血糖及血糖达标率等指标水平变化情况。结果护理后,与对照组比较,观察组对疾病知识的知晓率显著更高(P<0.05);观察组SDS与SAS水平均显著更低(P<0.05);观察组SDSCA量表各项评分均显著更大(P<0.05);观察组FPG、2h PG及HbA1C等水平均显著更低,血糖达标率显著更高(P<0.05)。结论临床治疗中选用多元化团体互动健康教育,可提升糖尿病患者对疾病知识的知晓度,有效缓解患者负性情绪,促使其积极主动配合治疗与护理,从而提高其自我管理能力,控制血糖水平,获得显著的护理有效性。

参与式健康教育工具包在2型糖尿病患者中的应用

目的:通过参与式糖尿病健康教育工具包的构建与实施,分析其对2型糖尿病患者疾病知识和健康行为的影响,从而提高患者的自我管理能力。方法:通过工具包设计、参与式研究、可行性评估、开发适合本土文化的糖尿病参与式健康教育工具包,并对此工具包进行验证。采用随机数字表法,将81例2型糖尿病患者随机分成对照组40例、干预组41例。对照组接受常规健康教育,干预组接受基于“参与式健康教育工具包”的“3-PR”健康教育管理,比较干预3个月后,两组患者糖化血红蛋白、糖尿病知识得分、糖尿病自我管理行为得分情况。结果:干预后,干预组患者糖化血红蛋白水平、糖尿病知识得分、糖尿病自我管理行为评分均明显优于对照组,差异均有统计学意义(P<0.05)。结论:采用参与式健康教育工具包能显著提高患者自我管理水平,改善血糖控制水平,值得未来在临床进一步推广。

基于住院-院后-门诊形式全程健康教育模式对2型糖尿病患者实施健康教育的效果研究

目的探讨应用全程健康教育模式对首次住院2型糖尿病患者实施健康教育的效果评价。方法选取2021年6月1日—2022年12月1日在滨州医学院附属医院住院的2型糖尿病患者130例,采用便利抽样法分为观察组和对照组,每组65例。对照组给予常规健康教育干预,观察组在常规健康教育基础上给予住院-院后-门诊形式全程健康教育模式干预。比较两组患者干预前后一般自我效能(GSES)评分、自我管理能力(SDSCA)评分、空腹血糖(FBG)、餐后2小时血糖(2 hPG)、糖化血红蛋白(HbA_(1c))的变化。结果干预后,观察组患者GSES评分、SDSCA评分、FBG、2 hPG、HbA_(1c)均优于对照组,差异有统计学意义(P<0.05)。结论基于住院-院后-门诊形式全程健康教育可提高2型糖尿病患者自我效能、自我管理能力,有利于血糖控制及稳定。

基于赋权教育的自我管理干预对农村糖尿病患者的影响

目的探讨实施基于赋权教育的自我管理干预对农村糖尿病患者自我管理能力的效果。方法选取内分泌科住院的78例农村糖尿病患者为研究对象,按照入院时间顺序分成对照组(2022年6-10月)和观察组(2022年11月至2023年3月)各39例。观察组接受基于赋权教育模式的自我管理方案;对照组接受常规的糖尿病宣教方案。比较两组干预后血糖控制水平、自我管理能力和疾病态度。结果观察组34例、对照组35例完成研究。两组出院当日,出院后3、6个月患者自我管理能力、糖尿病态度得分显著高于对照组,空腹血糖值显著低于对照组(均P<0.05)。结论实施基于赋权教育的自我管理方案可改善农村糖尿病患者对疾病的态度和血糖控制水平,提高自我管理能力。

5S健康教育模式对2型糖尿病患者口腔保健行为及知识知晓率的影响

目的 探讨5S健康教育模式对2型糖尿病(T2DM)患者口腔保健行为及知识知晓率的影响。方法 选择2021年9月至2022年9月收治的T2DM患者100例,患者随机分为对照组和观察组,每组50例。对照组给予常规健康教育方法,观察组采用5S健康教育模式进行干预,比较2组患者的干预效果、口腔保健行为及知识知晓率。结果 2组干预后的口腔保健行为优于干预前,且观察组优于对照组,差异有统计学意义(P<0.05)。观察组的口腔健康知识知晓率为92.00%(46/50),高于对照组的70.00%(35/50),差异有统计学意义(P<0.05)。2组干预后对口腔护理、疾病危害、注意事项的认知度评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。2组干预后对合理饮食、保持口腔卫生、定期口腔检查的评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。2组干预后的护患信任程度得分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。2组干预后的口腔健康影响程度量表(OHIP-14)评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论 5S健康教育模式用于T2DM患者中,效果显著,有利于患者进行口腔保护。

情境体验式健康教育对2型糖尿病病人心理健康状况及自我管理行为的影响

目的:探讨情景体验式健康教育对2型糖尿病(T2DM)病人心理健康状况及自我管理行为的影响。方法:选取2022年1月—12月的T2DM病人116例作为研究对象,采用随机数字表法将病人分为观察组和对照组,各58例。对照组行常规健康指导,观察组在对照组基础上实施情景体验式健康教育,干预3个月。比较两组干预前后心理健康状况、健康行为、血糖控制效果及生活质量改善情况。结果:干预后,观察组焦虑评分、抑郁评分、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)较对照组明显下降(P<0.05);观察组糖尿病病人自我管理行为量表(SDSCA)各维度评分及生存质量量表(DMQLS)较对照组明显提升(P<0.05)。结论:情景体验式健康教育能有效改善T2DM病人心理健康状况,提升病人自我管理行为,有效控制血糖,改善病人生活质量。

多元化健康教育对GDM孕妇胰岛素应用依从性影响

目的:探讨多元化健康宣传教育对妊娠期糖尿病(GDM)孕妇胰岛素应用依从性的影响。方法:纳入2021年1月-2023年1月本院产科收治的104例GDM孕妇进,随机数字表法分为对照组(52例,常规护理干预),观察组(52例,常规护理干预结合多元化健康宣教干预,干预至分娩,统计孕妇胰岛素应用依从性率、入院待产时血糖相关指标、自我管理评价量表(GDMS)评分、GDM健康知识掌握评分、生活质量量表(GDMQ)评分,妊娠结局及孕妇干预满意率。结果:观察组胰岛素应用依从性率(98.1%)高于对照组(86.5%),入院待产时糖化血红蛋白、空腹血糖与餐后2h血糖均低于对照组;干预后两组GDMS评分、GDM疾病健康知识掌握评分、GDMQ评分均得到改善,且观察组(85.34±3.94分、35.23±0.95分、78.24±5.82分)均优于对照组(63.23±4.74分、32.12±1.52分、51.25±6.23分)(P<0.05);观察组剖宫产率(23.1%)、妊娠期高血压疾病发生率(0)、新生儿低血糖发生率(0)均低于对照组(44.2%、7.7%、7.7%),孕妇干预满意率(96.2%)高于对照组(80.8%)(均P<0.05)。结论:多元化健康宣教可有效提升GDM孕妇胰岛素应用依从性,较好降低了孕妇血糖水平,提升孕妇自我管理能力、GDM疾病健康知识掌握度及生活质量,改善妊娠结局,提升了孕妇满意率。

以目标管理为导向的健康教育 在初发2型糖尿病患者护理中的应用效果分析

目的:分析以目标管理为导向的健康教育在初发2型糖尿病患者护理中的应用价值。方法:抽取2022年1月—2023年6月于滨州市中心医院确诊的初发2型糖尿病74例作为观察样本,通过随机数字表法分为对照组、观察组,各37例。对照组采用常规护理,观察组在对照组基础上采用以目标管理为导向的健康教育。比较两组护理效果。结果:护理后,两组空腹血糖、餐后2 h血糖、糖化血红蛋白水平以及体质量指数下降,且观察组较对照组低(P<0.05)。护理后,两组饮食管理、运动锻炼、血糖监测、自我足部检查、遵医嘱用药评分升高,且观察组较对照组高(P<0.05)。护理后,两组躯体功能、物质生活、社会功能、心理职能评分升高,且观察组较对照组高(P<0.05)。结论:以目标管理为导向的健康教育在初发2型糖尿病患者护理中的应用价值较高,能够有效提升患者的自我管理能力以及生活质量,更好地控制其血糖水平。

正念干预联合跨理论模型健康教育对糖尿病肾病血液透析患者症状负担及动静脉内瘘并发症的影响分析

目的探讨正念干预联合跨理论模型(the transtheoretical model,TTM)健康教育对糖尿病肾病血液透析患者症状负担及动静脉内瘘(arteriovenous fistula,AVF)并发症的影响。方法方便选取2022年1月—2023年8月山东省临沂市中医医院收治的者74例糖尿病肾病血液透析患为研究对象,依据不同护理方法分为两组,各37例。对照组实施常规护理,观察组在对照组基础上实施正念干预联合TTM健康教育护理,两组均干预3个月。对比两组症状负担[采用透析患者症状负担调查表评分(Dialysis Frequency Severity and Symptom Burden Index,DFSSBI)评估]、自我护理能力评分[采用血液透析患者AVF自我护理行为量表(Assessment Selfcare Behaviors Hemodialysis with Arteriovenous Fistual,ASBHD-AVF)评估]、AVF并发症发生情况。结果干预后,观察组DFSSBI中躯体症状、心理症状评分及总分均低于对照组,差异有统计学意义(P均<0.05)。干预后,观察组ASBHD-AVF评分中症状体征管理、并发症预防及总分均高于对照组,差异有统计学意义(P均<0.05)。观察组AVF并发症发生率为10.81%(3/37),低于对照组的32.43%(10/37),差异有统计学意义(χ^(2)=4.573,P<0.05)。结论糖尿病肾病血液透析患者实施正念干预联合TTM健康教育护理,能减轻患者症状负担,提高自我管理能力,减少并发症的发生。