健康餐盘对社区糖尿病患者血糖控制效果研究

背景　我国糖尿病发病率高，且糖尿病是我国重大的公共卫生问题。目前糖尿病无法治愈，而膳食治疗是糖尿病最基本的治疗手段，但目前的糖尿病膳食治疗有理论没技术，患者很难执行膳食治疗措施。目的　研究健康餐盘对糖尿病患者的血糖控制效果，为今后推广应用提供科学依据。方法　2018年5月-2019年5月，采用立意抽样的方法，选择舟山市新城社区卫生服务中心辖区的6个工作管理水平相似的服务站，选取在册管理1年以上的社区糖尿病患者117例为研究对象。采用抽签的方法，将患者分成试验组（59例）和对照组（58例）。对两组患者进行糖尿病膳食健康教育培训，同时进行常规膳食指导，其中试验组用健康餐盘作为食物的计量工具，对照组无健康餐盘干预。干预前，试验组血糖未达标者有22例，对照组血糖未达标者有20例。比较并分析两组患者一般资料、干预前后体格检查指标〔体质指数（BMI）、血压（BP）、腰围（WC）〕和生化指标〔空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）〕，两组干预前血糖未达标者干预前后体格检查指标和生化指标。结果　两组性别、年龄、职业、文化程度、运动情况、规律用药情况比较，差异均无统计学意义（P>0.05）。干预前、干预1年后，两组BMI、BP、WC、FPG、HbA1c、TC、TG、LDL-C、HDL-C比较，差异均无统计学意义（P>0.05）。对照组干预1年后BMI、BP、WC、FPG、HbA1c、TC、TG、LDL-C、HDL-C与本组干预前比较，差异无统计学意义（P>0.05）；试验组干预1年后BMI、BP、WC、FPG、TC、TG、LDL-C、HDL-C与本组干预前比较，差异无统计学意义（P>0.05）；试验组干预1年后HbA1c低于本组干预前（P<0.05）。干预前、干预1年后，两组干预前血糖未达标者BMI、BP、WC、FPG、TC、TG、LDL-C比较，差异均无统计学意义（P>0.05）；干预前、干预1年后，试验组干预前血糖未达标者HbA1c、HDL-C低于对照组（P<0.05）。对照组、试验组干预前血糖未达标者干预1年后HbA1c低于本组干预前（P<0.05）。结论　健康餐盘联合营养教育可有效控制社区糖尿病患者的血糖水平，值得在社区糖尿病患者中推广应用。

Effect of Healthy Eating Plate on Blood Glucose Control in Diabetic Patients in the Community

Background　China has a high incidence of diabetes，which is a major public health issue.There is no cure for diabetes，and dietary therapy is the most basic treatment for diabetes.Diabetes can not be cured currently，and is treated essentially by dietary therapy.However，although there are abundant theories about dietary therapy，it is difficult for patients to implement due to lack of implementation techniques.Objective　To study the effect of healthy eating plate on glycemic control in diabetic patients，to provide a scientific basis for further promoting its application.Methods　Participants were 117 community-dwelling diabetic patients who were registered and were managed for more than one year at 6 community health stations with similar management level in service areas of Newcity Community Health Center in Zhoushan City selected by purposive sampling from May 2018 to May 2019.By the lottery number drawn subjectively，they were divided into experimental（59 cases）and control（58 cases）groups.Both groups received the same education concerning dietary therapy and normal dietary guidance，but the control group used common eating utensils，the experimental group used healthy eating plates for providing detailed guidance for eating.The general data，anthropometric indices（BMI，BP，and WC）and biochemical indices（FPG，HbA1c，TC，TG，LDL-C，HDL-C）of the two groups were analyzed comparatively before and after the intervention.Anthropometric and biochemical indices were further compared between those who failed to reach glycemic targets in the two groups（22 in the experimental group and 20 in the control group）.Results　There were no statistically significant differences between the two groups in gender ratio，mean age，occupation，education level，exercise and regular drug use（P>0.05）.Before intervention and at 1 year after intervention，there were no statistically significant differences in mean BMI，BP，WC，FPG，HbA1c，TC，TG，LDL-C and LDL-C between the two groups（P>0.05）.After 1 year intervention，mean BMI，BP，WC，FPG，HbA1c，TC，TG，LDL-C，and HDL-C showed no significant changes in the control group compared with those before intervention（P>0.05），and they also changed insignificantly in the experimental group（P>0.05） except that HbA1c showed a significant reduction（P<0.05）.Patients who failed to reach glycemic targets the experimental group had similar mean levels of BMI，BP，WC，FPG，TC，TG and LDL-C（P>0.05），but lower mean levels of HbA1c and HDL-C compared to those in the control group before intervention and at one year after intervention（P<0.05）.The mean level of HbA1c decreased significantly in both groups compared to the baseline level（P<0.05）.Conclusion　The application of healthy eating plate combined with nutrition education can effectively control the blood glucose level，which is worthy to be popularized in community-dwelling diabetic patients.