目的：调查社区2型糖尿病患者糖代谢指标情况、糖尿病知识掌握情况及自我管理水平的现状，并对采用自我管理模式干预后作出评价。方法采用“中国2型糖尿病病人自我管理情况调查问卷”进行调查分析自我管理现状。将428例社区2型糖尿病患者随机分为同伴教育模式管理组（试验组）216例和社区常规教育管理模式组（对照组）212例。对照组按照社区常规教育管理模式对糖尿病患者进行健康教育、发放健康教育宣传资料进行干预；试验组采用自我管理模式，由教育者组织糖尿病患者进行自我管理课程的学习，定期开展各项主题活动，并有针对性地进行干预。比较干预3、6个月后，2组患者的评价指标即糖代谢指标达标率、糖尿病知识水平达标率和自我管理得分等方面的变化情况。结果①干预前2组患者的糖代谢指标达标率、糖尿病知识掌握达标率、自我管理水平得分比较，差异无统计学意义（P＞0．05）；干预后3、6个月，2组患者的糖代谢指标达标率、糖尿病知识掌握达标率、自我管理水平得分均有上升，但试验组比对照组上升率大，差异均有统计学意义（P＜0．05）。②从糖尿病患者自我管理的各个分量表中得出，在干预前，干预后3、6个月，试验组和对照组的药物依存性平均分最高，监测依存性平均分最低。结论糖尿病自我管理模式明显优于社区常规教育管理模式。采用自我管理模式的方式进行教育，能使患者的自我管理水平明显提高。在糖尿病自我管理的4项内容中，告知患者自我监测的重要性是医护人员健康宣教的重点。%Objective To investigate the current situation of glucose metabolism indexes, awareness of dia-betes, and self-management of type 2 diabetics in the community, and to evaluate the effect of intervention on self-management pattern. Method The "questionnaire on self-management in Chinese type 2 diabetics" was used to ex-amine and analyze the current situation of patients′ self-management. 428 cases of the type 2 diabetics in the com-munity were randomly divided into two groups: 216 cases with peer-education management (experimental group) and 212 cases with routine community education management (control group). For the control group, the diabetics were in-tervened by health education and handouts according to the routine community education management pattern; for the experimental group, the diabetics were organized to take courses of self-management and to attend various theme ac-tivities periodically by instructors as well to achieve the targeted intervention on the basis of peer-education manage-ment pattern. After 3 and 6 months of intervention, the changes in the evaluation indexes, including the control rate of glucose metabolism, intended awareness of diabetes, and the score of self-management level were compared between two groups. Results ①Before the intervention, there were no statistical differences in the control rate of glucose metabolism, awareness of diabetes and self-management score between the two groups (P>0.05). After 3 and 6 months of the intervention, these figures were improved in the both groups; however, the experimental group showed greater increases than the control group (all P<0.05). ②Of all domains of self-management, the mean sub-score of compliance to medication was the highest and that of compliance to monitoring was the lowest in both the experimental group and control group, before intervention, after 3-month intervention, and after 6-month intervention. Conclusion For diabetics, self-management pattern has obvious advantage over the routine community education management pattern. Education by self-management pattern can significantly improve the self-management level in the patients. Among the four do-mains of diabetes self-management, the importance of self-monitoring remains to be the focus of health education by medical professionals.
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