中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2012年
2期
85-89
,共5页
于文%韩静%孙迎俊%孟丽珍%甄桂兰%张栩
于文%韓靜%孫迎俊%孟麗珍%甄桂蘭%張栩
우문%한정%손영준%맹려진%견계란%장허
糖尿病,2型%药物治疗依从性%病人教育%家属
糖尿病,2型%藥物治療依從性%病人教育%傢屬
당뇨병,2형%약물치료의종성%병인교육%가속
Diabetes mellitus,type 2%Medication adherence%Patient education%Family members
目的 探索建立家属以监管身份参与糖尿病教育管理的新模式.方法 建立以医生为总管理者、患者家属为督促者、患者为自我管理者、护士为施教者的MUST糖尿病管理模式,采用改良的Deborah糖尿病自我管理评价表进行依从性判定.对2010年6至7月收治的180例2型糖尿病患者采用区组随机的方法分为干预组和对照组(各90例)进行1年的观察.干预组男47例,女43例,平均年龄(52±12)岁,病程(10±3)年.对照组男46例,女44例,平均年龄(52±12)岁,病程(11±4)年.其中干预组进入MUST管理模式,对照组采用传统的糖尿病教育模式,分析比较两组依从性的改进情况.两组均数比较用配对或独立样本t检验,计数资料用卡方检验.结果 干预组患者完全从医行为观察结束时比观察开始时提高超过1倍(75.6％比34.4％,x2=30.01,P＜0.05),而且从进入MUST模式的第3个月依从性改善就有明显提高(67.8％比34.4％,x2=20.01,P＜0.05),半年后依从性改善维持高水平,直到观察结束,但在观察后期略有下降.从第3个月开始,完全从医人数干预组与同时期对照组比较差异均有统计学意义(均P＜0.01).对依从性五大分项的分析显示影响对照组依从性的主要因素是饮食和运动.两组观察结束后,合理的运动强度(OR=2.555,P=0.000)、胰岛素合理使用(OR =4.812,P=0.002)、低盐低脂饮食(OR=5.028,P=0.029)、合理血糖监测频率(OR=20.656,P=0.000)以及合理运动频率(OR=6.560,P=0.001)5个单项对依从性改善影响最大.结论 MUST模式强调家属作为监督者的身份参与糖尿病教育的重要性,可显著提高患者的依从性.
目的 探索建立傢屬以鑑管身份參與糖尿病教育管理的新模式.方法 建立以醫生為總管理者、患者傢屬為督促者、患者為自我管理者、護士為施教者的MUST糖尿病管理模式,採用改良的Deborah糖尿病自我管理評價錶進行依從性判定.對2010年6至7月收治的180例2型糖尿病患者採用區組隨機的方法分為榦預組和對照組(各90例)進行1年的觀察.榦預組男47例,女43例,平均年齡(52±12)歲,病程(10±3)年.對照組男46例,女44例,平均年齡(52±12)歲,病程(11±4)年.其中榦預組進入MUST管理模式,對照組採用傳統的糖尿病教育模式,分析比較兩組依從性的改進情況.兩組均數比較用配對或獨立樣本t檢驗,計數資料用卡方檢驗.結果 榦預組患者完全從醫行為觀察結束時比觀察開始時提高超過1倍(75.6％比34.4％,x2=30.01,P＜0.05),而且從進入MUST模式的第3箇月依從性改善就有明顯提高(67.8％比34.4％,x2=20.01,P＜0.05),半年後依從性改善維持高水平,直到觀察結束,但在觀察後期略有下降.從第3箇月開始,完全從醫人數榦預組與同時期對照組比較差異均有統計學意義(均P＜0.01).對依從性五大分項的分析顯示影響對照組依從性的主要因素是飲食和運動.兩組觀察結束後,閤理的運動彊度(OR=2.555,P=0.000)、胰島素閤理使用(OR =4.812,P=0.002)、低鹽低脂飲食(OR=5.028,P=0.029)、閤理血糖鑑測頻率(OR=20.656,P=0.000)以及閤理運動頻率(OR=6.560,P=0.001)5箇單項對依從性改善影響最大.結論 MUST模式彊調傢屬作為鑑督者的身份參與糖尿病教育的重要性,可顯著提高患者的依從性.
목적 탐색건립가속이감관신빈삼여당뇨병교육관리적신모식.방법 건립이의생위총관리자、환자가속위독촉자、환자위자아관리자、호사위시교자적MUST당뇨병관리모식,채용개량적Deborah당뇨병자아관리평개표진행의종성판정.대2010년6지7월수치적180례2형당뇨병환자채용구조수궤적방법분위간예조화대조조(각90례)진행1년적관찰.간예조남47례,녀43례,평균년령(52±12)세,병정(10±3)년.대조조남46례,녀44례,평균년령(52±12)세,병정(11±4)년.기중간예조진입MUST관리모식,대조조채용전통적당뇨병교육모식,분석비교량조의종성적개진정황.량조균수비교용배대혹독립양본t검험,계수자료용잡방검험.결과 간예조환자완전종의행위관찰결속시비관찰개시시제고초과1배(75.6％비34.4％,x2=30.01,P＜0.05),이차종진입MUST모식적제3개월의종성개선취유명현제고(67.8％비34.4％,x2=20.01,P＜0.05),반년후의종성개선유지고수평,직도관찰결속,단재관찰후기략유하강.종제3개월개시,완전종의인수간예조여동시기대조조비교차이균유통계학의의(균P＜0.01).대의종성오대분항적분석현시영향대조조의종성적주요인소시음식화운동.량조관찰결속후,합리적운동강도(OR=2.555,P=0.000)、이도소합리사용(OR =4.812,P=0.002)、저염저지음식(OR=5.028,P=0.029)、합리혈당감측빈솔(OR=20.656,P=0.000)이급합리운동빈솔(OR=6.560,P=0.001)5개단항대의종성개선영향최대.결론 MUST모식강조가속작위감독자적신빈삼여당뇨병교육적중요성,가현저제고환자적의종성.
Objective To improve compliance of patients with type 2 diabetes mellitus with a new education mode involving the patients' family members.Methods Set up a diabetes education mode joined by the doctors (manager,M),the patients' family members(urger,U),the patients (self-manager,S)and the nurses ( teacher,T) (MUST).The improvement of compliance in 180 patients treated from June to July 2010 was evaluated with modified Deborah's diabetes knowledge and self-management skills self-evaluate table.The patients were divided block-randomly into intervention group and control group (90 patients in each group).There were 47 males and 43 females in intervention group with a mean age of (52 ± 12 )yrs and a disease-course of ( 10 ± 3) yrs ; there were 46 males and 44 females in control group with a mean age of (52 ± 12) yrs and a disease-course of ( 11 ± 4) yrs.The patients in intervention group were educated with MUST mode for 1 year,and meanwhile the patients in control group were educated in traditional education system.The compliance change of patients was compared between the two groups. The t test was used in paired- or indipendent-samples analysis and x2 test in counting variable.Results The good compliance in intervention group at the end of observation improved more than 1 time compared with that at the beginning (75.6％ vs 34.4％,P ＜0.01 ).This improvement was observed at the point of the 3rd month(67.8％,P ＜0.01 ) and kept in this high level to the end of the observation. From the 3rd month on,the good compliance in intervention group at each point of observation were statistically higher than those in control group ( all P ＜ 0.01 ). Diet and exercise were the barriers to compliance improvement in control group according to the analysis of the five sub-items of compliance.Advisable exercise intensity( OR =2.555,P =0.000),advisable use of insulin ( OR =4.812,P =0.002 ),low-salt and low-fat diet ( OR =5.028,P =0.029),advisable blood sugar monitoring frequency ( OR =20.656,P =0.000) and advisable exercise frequency ( OR =6.560,P =0.001 ) were the most 5 single items affected to compliance improvement in two groups.Conclusions The urger role of the family members of the type 2 diabetic patients is most important in the MUST educational system for these patient to improve the compliance reliably.
