2型糖尿病患者自我管理、饮食依从性、心理负担与血糖水平的相关研究

目的 了解2型糖尿病患者的自我管理知识态度行为、饮食依从性、心理负担的现状,探讨其与血糖水平之间的关联。 方法 采用随机抽样法选取2019年9月—2020年10月在潍坊市某三甲医院就诊的2型糖尿病患者330例为调查对象,应用一般资料调查表、人体指标检测表、糖尿病患者自我管理知识态度行为评价简化量表、糖尿病患者饮食行为依从性测评量表、糖尿病痛苦量表进行问卷调查,采用二元logistic回归分析自我管理、饮食依从性、心理负担的影响因素,应用Spearman相关分析自我管理、饮食依从性、心理负担的相关性,采用多重线性逐步回归分析血糖水平的影响因素。结果 330例研究对象中HbA1c<7%者共99例(30.00%),自我管理合格、饮食依从性合格、略微心理负担者分别为184、189、150例(占比:55.76%、57.27%、45.45%)。二元logistic回归分析结果显示,居住地(OR=0.495,95%CI:0.280～0.874)、病程(OR=1.771,95%CI:1.421～2.206)、因糖尿病住院次数(OR=2.481,95%CI:1.396～4.408)、是否接受过专业系统宣教(OR=3.649,95%CI:1.239～10.751)、药物饮食运动联合控制(OR=4.354,95%CI:2.419～7.838)是自我管理的影响因素;年龄(OR=1.525,95%CI:1.119～2.078)、性别(OR=2.543,95%CI:1.465～4.415)、是否接受过专业系统宣教(OR=3.085,95%CI:1.368～6.960)、药物饮食运动联合控制(OR=11.910,95%CI:6.323～22.432)是饮食依从性的影响因素;年龄(OR=0.739,95%CI:0.559～0.979)、病程(OR=0.543,95%CI:0.449～0.657)是心理负担的影响因素。自我管理与饮食依从性、与心理负担,饮食依从性与心理负担相关(r=0.586、-0.443、-0.168,P<0.05)。多重线性逐步回归分析结果显示,饮食依从性、握力、药物饮食运动联合控制、心理负担是2型糖尿病患者血糖水平的影响因素(P<0.05)。 结论 2型糖尿病患者血糖水平与饮食依从性、心理负担、联合控制方式等密切相关;制定综合防控措施,着力提高饮食依从性,提升握力水平,有助于糖尿病患者维持良好的血糖水平。

Correlation of self-management,dietary compliance and psychological burdenwith glycemic level in patients with type 2 diabetes mellitus

Objective To understand the current status of knowledge, attitude and behavior about self-management, dietary compliance and psychological burden in patients with type 2 diabetes mellitus, and to explore their associations with glycemic level. Methods A random sampling method was used to select 330 patients with type 2 diabetes mellitus hospitalized in a grade-A tertiary hospital in Weifang City from September 2019 to October 2020 to serve as the research subjects. Generalinformation questionnaire, human index test table, Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale, Dietary Behavior Compliance Scale and Diabetes Distress Scale were used to carry out questionnaire surveys. Binary logistic regression analysis was applied to identifying the factors influencing self-management, dietary compliance and psychological burden. Spearman correlation analysis was employed to analyze the correlation among self-management, dietary compliance, andpsychological burden. Multiple linear stepwise regression analysis was conducted to analyze the factors affecting glycemic level. Results Among the 330 research subjects, there were 99 (30.00%) cases with HbA1c < 7%, 184 (55.76%) cases with qualified self-management, 189 (57.27%) cases with qualified diet compliance and 150 (45.45%) cases with slight psychological burden. Binary logistic regression analysis showed that residence (OR=0.495, 95%CI: 0.280-0.874), course of the disease (OR=1.771, 95%CI: 1.421-2.206), hospitalization frequency of diabetes (OR=2.481, 95%CI: 1.396-4.408), whether or not receiving professional systematic education (OR=3.649, 95%CI: 1.239-10.751) and combined control based on medicine, diet and exercise (OR=4.354, 95%CI: 2.419-7.838) were the factors influencing self-management. Age (OR=1.525, 95%CI:1.119-2.078), gender (OR=2.543, 95%CI: 1.465-4.415), whether or not receiving professional systematic education (OR=3.085, 95%CI: 1.368-6.960) and combined control based on medicine, diet and exercise (OR=11.910, 95%CI: 6.323-22.432) were the factors influencing dietary compliance. Age (OR=0.739, 95%CI: 0.559-0.979) and course of the disease (OR=0.543, 95%CI:0.449-0.657) were the factors influencing psychological burden. There was a correlation between self-management and dietary compliance, psychological burden as well as between dietary compliance and psychological burden (r=0.586, r=-0.443, r=-0.168; all P<0.05). Multiple linear stepwise regression analysis showed that dietary compliance, grip strength, combined control based on medicine, diet and exercise and psychological burden were the factors influencing the glycemic level of the patients with type 2 diabetes mellitus (P<0.05). Conclusion The glycemic level of the patients with type 2 diabetes mellitus is closely related to dietary compliance, psychological burden and combined control mode. Developing comprehensive prevention and control measures and improving dietary compliance and grip strength are conducive to helping the diabetic patients maintain good glycemic level.