初次自行胰岛素注射治疗2型糖尿病患者基于微信管理注射相关风险的效果观察

目的观察初次自行胰岛素注射治疗2型糖尿病患者行基于微信注射相关风险管理的效果及安全性。方法将2017年4月至2018年7月在解放军第九〇三医院内分泌科住院且出院后初次自行胰岛素注射治疗的124例2型糖尿病患者,出院时按出院月份分为对照组和观察组,各62例。两组住院期间均行常规的胰岛素注射相关知识教育;出院后,观察组在微信公众号观看讲解胰岛素注射知识与技术的视频,微信群每周推送糖尿病相关知识。结果出院后4周随访,观察组与对照组注射胰岛素时的正确皮肤消毒36(58%)与11(18%)例,χ²=21.42,P<0.01]、注射前排气62(100%)与51(82%)例,χ²=12.07,P<0.01]、注射后停留10 s60(97%)与47(76%)例,χ²=11.52,P<0.01]、正确处理废用针头49(79%)与18(29%)例,χ²=31.20,P<0.01]、注射部位轮换48(77%)与35(56%)例,χ²=6.16,P=0.01]、正确储存胰岛素62(100%)与57(92%)例,χ²=5.21,P=0.02]及正确处理低血糖情况52(84%)与38(61%)例,χ²=7.94,P=0.01]比较,差异均有统计学意义;出院后12周,观察组与对照组的空腹血糖(6.41±0.76)与(7.19±0.81)mmol/L,t=5.61,P<0.01]、糖化血红蛋白水平(6.71±0.64)%与(7.37±0.78)%,t=5.18,P<0.01]、低血糖发生率10%(6/62)与24%(15/62),χ²=4.64,P=0.03]比较,差异均有统计学意义。结论通过微信进行注射相关风险管理能有效提高患者胰岛素注射的技能,降低居家胰岛素治疗的风险,提高血糖达标率。

The efficacy and safety of injection-related risk management based on WeChat platform in type 2 diabetic patients with the first insulin self-injection

Objective To assess the implementation of injection-related risk management based on WeChat platform for type 2 diabetic patients with the insulin self-injection.Methods A total of 124 diabetic patients,who would receive insulin therapy by self-injection at home after discharge from the PLA 903 hospital during April 2017 to July 2018,were divided into the control group(n=62)and the study group(n=62).All patients were given routine education on insulin injection during the hospitalization,while the study group(n=62)received additional video and text education based on WeChat platform after discharge.The skill of self-injection and the status of blood glucose control were evaluated in both groups 4 weeks and 8 weeks after discharge,respectively.Results The insulin injection skill,including skin disinfection36(58%)vs.11(18%),χ2=21.42,P<0.01],exhaust before injection62(100%)vs.51(82%),χ2=12.07,P<0.01],stay 10s after injection60(97%)vs.47(76%),χ2=11.52,P<0.01],disposal of used needle49(79%)vs.18(29%),χ2=31.20,P<0.01],rotation of injection site48(77%)vs.35(56%),χ2=6.16,P=0.01],insulin storage62(100%)vs.57(92%),χ2=5.21,P=0.02],and the ability of correctly dealing with hypoglycemia52(84%)vs.38(61%),χ2=7.94,P=0.01]in the study group were significantly better than those in the control group after 4 weeks of injection-related risk management.The fasting plasma glucose(6.41±0.76)vs.(7.19±0.81)mmol/L,t=5.61,P<0.01],glycosylated hemoglobin A1c(6.71±0.64)%vs.(7.37±0.78)%,t=5.18,P<0.01],incidence of hypoglycemia6(10%)vs.15(24%),χ2=4.64,P=0.03]in the study group were significantly lower than those in the control group after 12 weeks of the management.Conclusion The risk management based on WeChat platform can improve insulin self-injection skill and the ability of dealing with hypoglycemia,also promote effective blood glucose control for diabetes patients.