健康教育与2型糖尿病患者血糖控制和自我护理行为的相关性研究

目的了解我国糖尿病健康教育现状，探讨健康教育及其全面程度与2型糖尿病患者血糖控制及自我护理行为的相关性。方法2010年4至7月招募来自50个医学中心的5200例2型糖尿病患者，采用问卷和糖尿病自护行为量表（SDSCA）进行调查。根据其是否接受过糖尿病健康教育及接受教育的全面程度将患者分为：未接受过教育者（971例）、接受过1～2方面教育的患者（532例）、接受过3～4方面教育的患者（1001例）、接受过5—6方面教育的患者（2696例）。应用方差分析检验4组问计量资料的差异。结果四组患者的年龄（F=7．75，P〈0．05）、病程（F=32．86，P〈0．05）及部分并发症发生率存在显著差异。四组患者的血糖水平与血糖达标率均存在显著差异，其中接受5—6方面教育者空腹血糖（47．62％比36．81％，x^2=30．05，P〈0．05）、餐后2h血糖（49．03％比37．76％，x^2=29．40，P〈0．05）及糖化血红蛋白（34．94％比26．65％，x^2=11．82，P〈0．05）的达标率均显著高于未接受教育者。四组患者的自我护理行为评分存在显著差异，其中接受5～6方面教育者在饮食控制（4．5±1．5比3．6±1．7，t=0．818，P〈0．05）、运动锻炼（4．5±2．5比3．4±2．6，t=1．082，P〈0．05）、自我血糖监测（3．2±2．6比2．5±2．7，t：0．672，P〈0．05）、足部护理（4．8±1．8比3．7±1．8，t=1．033，P〈0．05）、用药方案（6．3±1．5比5．8±2．0，t=0．556，P〈0．05）自我护理评分均显著高于未接受教育者。结论我国糖尿病健康教育范围狭窄、内容欠全面。接受全面的糖尿病健康教育可能会帮助2型糖尿病患者控制血糖并形成更好的糖尿病自护行为习惯。

Relationship between diabetes education on disease management and self-care activities of patients with type 2 diabetes

Objective To survey the characteristics of diabetes education of patients with type 2 diabetes mellitus in China and investigate the relationship between diabetes education and disease management and self-care activities of the patients. Methods General questionnaire and the summary of diabetes self-care activities （SDSCA） scale were adopted from April to July in 2010 in this muhi-center, cross-section survey, to interview 5200 patients with type 2 diabetes mellitus from 50 medical centers. Based on the questionnaire, patients were divided into 4 groups： uneducated （971 cases） , been educated in 1 -2 respects （532 cases）, been educated in 3 -4 respects （1001 cases）, been educated in 5 -6 respects （2696 cases）. Data of up-mentioned 4 groups were compared by analysis of variance. Results Age （F = 7.75, P 〈 O. 05 ） , duration of diabetes （ F = 32. 86, P 〈 0. 05 ） and incidence rate of several complications were significant different among the 4 groups. Percentages of individuals who reached the recommended level of fasting plasma glucose（FPG） , two-hour postprandial plasma glucose （2 h PG） and glycated hemoglobin Alc（HbAlc） were significantly different among the 4 groups. Compared with those in the uneducated individuals, higher percentage of individuals been educated for 5 - 6 respects achieved the targets of FPG ≤ 7.0 mmoL/L （47.62% vs 36.81%, x2 =30.05, P 〈0.05）, 2 h PG≤10.0 mmoL/L （49.03% vs 37.76%,x2=29.40, P〈0.05） and HbAlc 〈7% （34.94% vs26.65%,x2=11.82, P〈0.05）. Mean scores of self-care behaviors were significantly different among the 4 groups. Individuals been educated for 5 -6 respects suggested higher mean scores in diet management （4. 5 ± 1.5 vs 3.6 ± 1.7, t =0. 818, P 〈 0. 05 ）, physical exercise （4. 5 ±2. 5 vs 3.4 ±2. 6, t = 1. 082, P 〈 0. 05 ） , self glucose monitoring （3.2 ±2.6 vs2.5±2.7, t=0.672, P〈0.05）, foot care （4.8 ±1.8 vs3.7±1.8, t=1.033, P〈0.05） and medications （6. 3 ±1.5 vs 5.8 ±2.0, t = 0. 556, P 〈 0. 05） than those in uneducated individuals. Conclusions Only a few patients in China had accepted comprehensive diabetes education. Both diabetes education and its comprehensiveness might contribute to better glycemic control and self-care behaviors of patients with type 2 diabetes mellitus.