社区2型糖尿病患者自我管理行为与糖尿病视网膜病变的相关分析

doi:10.13281/j.cnki.issn.1004-4469.2016.05.010

摘要/Abstract

摘要：

目的了解社区2型糖尿病（T2DM）患者自我管理行为与糖尿病视网膜病变（DR）的关系。设计横断面研究。研究对象 2015年7月在深圳市银湖社康中心进行年度体检的T2DM患者252例。方法采用糖尿病患者自我管理行为量表进行问卷调查，根据结果将患者分为自我管理行为良好、中等、不良。同时测定空腹血糖（FBG）、糖化血红蛋白（HbA1c）。根据眼底检查分为无糖尿病视网膜病变（DWR）、非增生性糖尿病视网膜病变（NPDR）和增生性糖尿病视网膜病变（PDR），比较DR患者与DWR患者的自我管理行为以及血糖指标控制情况。主要指标 糖尿病自我管理行为、FBG、HbA1c水平。结果 252例T2DM患者中228例（90%）完成调查，其中DR者62例（27.2%），病程10年以上DR患者34例（54.8%），明显多于DWR患者（65例，39.2%）（χ2=4.519，P=0.034）。228例T2DM患者自我管理行为良好率20.6%、中等50.9%、不良28.5%；其中，DR患者自我管理行为良好率11.3%低于DWR患者（24.1%）（χ2=4.524，P=0.033）。228例T2DM患者血糖控制达标率FBG 29.4%、HbA1c 28.5%；其中DR患者血糖控制达标率FBG 19.4%、HbA1c 17.7%，低于DWR患者FBG 33.1%、HbA1c 32.5%（χ2=4.129，P=0.042；χ2=4.844，P=0.028）。病程为<5年、5~10年、>10年的T2DM患者自我管理行为不良率分别为15.0%、20.2%、41.4%（χ2=16.764，P=0.002）。分级为DWR、NPDR、PDR的T2DM患者自我管理行为不良率分别为25.9%、28.0%、66.7%（χ2=9.132，P=0.010）。多因素Logistic回归分析模型中，饮食行为（OR=0.241，95%CI:0.163~0.287）、运动行为（OR=0.536，95%CI:0.481~0.692）、遵医嘱用药（OR=0.056，95%CI:0.018~0.172），FBG达标率（OR= 2.255，95%CI:1.315~3.873）、HbA1c达标率（OR=1.376，95%CI:1.197~1.584）以及糖尿病病程（OR=0.573，95%CI:0.038~0.714）与DR的发生及严重程度相关。结论糖尿病病程长、饮食控制不佳、较少运动、用药欠规范和FBG、HbA1c控制不达标与DR的发病相关，提高社区T2DM患者自我管理行为有助于血糖控制，降低DR发生的风险。（眼科，2016, 25： 326－329）

关键词: 2型糖尿病, 糖尿病视网膜病变, 社区, 自我管理行为

Abstract:

Objective To investigate the association of self-management behaviors (SMB) and diabetic retinopathy (DR) in patients with type 2 diabetes(T2DM) in community. Design Cross-sectional study. Participants A total of 252 patients with T2DM in annual health examination in Yinhu community health care centers in Shenzhen. Methods All patients were surveyed using the summary of diabetes self-care activities questionnaire (SDSCA), and divided into behavior good, medium and poor according to the results, and tested fasting blood-glucose (FBG) and glycosylated haemoglobin(HbA1c ). Patients were classified into diabetic without retinopathy (DWR), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) according to fundus examination. The differences of the levels of SMB and blood glucose between DR and DWR were compared. Main Outcome Measures The levels of SMB, FBG and HbA1c. Results 228 cases of 252 patients with T2DM completed the surveys and the response rate was 90%. There were 62 cases(27.2%) with DR. The duration of diabetes was more than 10 years in 34 cases (54.8%) with DR and 65 cases (39.2%) with DWR (χ2=4.519, P=0.034). Of 228 cases with T2DM, the level of SMB was satisfactory and good in 20.6%, medium in 50.9%, and poor in 28.5%. Of 228 cases with T2DM, 29.4% had achieved an ideal level of FBG and 28.5% had an ideal level of HbA1c. The good rate of the level of SMB in cases with DR and DWR was 11.3% and 24.1% respectively(χ2=4.524, P=0.033). Of the cases with DR, 19.4% and 17.7% had achieved an ideal level of FBG and HbA1c, and of the cases with DWR the corresponding rate was 33.1% and 32.5% respectively(χ2=4.129, P=0.042; χ2=4.844, P=0.028). The poor rate of SMB was 15.0%, 20.2% and 41.4% respectively in patients with duration of diabetes less than 5 years, 5~10 years and more than 10 years respectively, and 25.9%, 28.0% and 66.7% in patients which classified as DWR, NPDR and PDR(χ2=16.764, P=0.002; χ2=9.132, P=0.010). In the multifactor Logistic regression model, diet behavior (OR=0.241, 95%CI:0.163~0.287), exercise behavior (OR=0.536, 95%CI: 0.481~0.692), following directions to take medications (OR=0.056, 95%CI:0.018~0.172), FBG≤7.0 mmol/L (OR=2.255, 95%CI:1.315~3.873), HbA1c≤7.0% (OR=1.376, 95%CI:1.197~1.584) and duration of diabetes(OR=0.573, 95%CI: 0.038~0.714) were associated with higher risk of DR. Conclusion Higher risk of DR is associated with longer duration of diabetes, poor diet, less exercise, lower obedience to use medicine, lower rate of the control of FBG and HbA1c to normal level. This study suggested that improving the levels of SMB would be benefitial to controlling glucose levels and reduced the risk of DR in patients with T2DM in community. （Ophthalmol CHN，2016, 25： 326－329）

Key words: type 2 diabetes, diabetic retinopathy, community, self-management behaviors

郭丽花杨智明蔡亮杰. 社区2型糖尿病患者自我管理行为与糖尿病视网膜病变的相关分析[J]. 眼科, doi: 10.13281/j.cnki.issn.1004-4469.2016.05.010.

GUO Li-hua, YANG Zhi-ming, CAI Liang-jie. Correlation between self-management behaviors and diabetic retinopathy in patients with type 2 diabetes in community[J]. Ophthalmology in China, doi: 10.13281/j.cnki.issn.1004-4469.2016.05.010.

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社区2型糖尿病患者自我管理行为与糖尿病视网膜病变的相关分析

Correlation between self-management behaviors and diabetic retinopathy in patients with type 2 diabetes in community

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