门诊糖尿病患者的自我管理水平及其对血糖控制的影响

目的了解门诊糖尿病患者自我管理现状及其对血糖控制的影响。方法对随机选取的281例门诊糖尿病患者通过问卷调查和病案摘录，获得近3个月的饮食、锻炼、自我监测、血糖控制等信息，采用因子分析改进的Logistic回归模型探索自我管理与血糖控制间的关系。结果50％以上患者在饮食、锻炼、药物治疗方面执行较好，23％监测间隔过长，监测方式以医院测定和自备血糖仪为主，56％和47％的患者存在血压或血脂异常，男性和60岁以下患者在自我管理方面不及女性和60岁以上者。社会经济地位高、糖尿病积极治疗是血糖控制的保护性因素，胆固醇异常、自我监测差与血糖控制差正相关，其调整后比值比分别为0．59、0．39、1.89和1．83。结论男性和60岁以下患者是加强自我管理的重点人群，自我监测、锻炼、饮食等会对血糖控制产生独立影响。

Diabetes self-management skills and their effects on glycemic control among outpatients

Objective To study diabetes self-management skills among outpatient diabetics and their influence on glycemic control. Methods Data were collected from 281 diabetes patients recruited in Tianjin Medical University Metabolic Hospital using a questionnaire coveting their diet, physical exercise and glycemic self-monitoring during the last three months. Additional HbA1 c and blood lipid information were retrieved from medical records. Logistic regression modified by factor analysis was then conducted. Results More than half patients did well in diet control, physical exercise and drug treatment. 23% patients exceeded physician-recommended intervals for self-monitoring. Self-monitoring was primarily conducted through hospital testing or family-owned glucometers. Abnormal blood pressure （53 %） or lipid （47 % ） levels were also common. Overall, self-management practices among men and the younger（（60yr） were worse than that among women and elderly people. The significant related factors for good glyeemic control included higher socioeconomic status and positive treatment, but Abnormal cholesterol and inadequate self-monitoring were related with poor glycemic control with the adjusted odds ratios equaling to 0. 59, 0. 39, 1.89 and 1.83, respectively. Conclusions More attention should be taken on men and the younger （〈60yr）to improve their skills of self-management. Self-monitoring, physical exercise, diet control, etc. independently influence blood glucose control.