社区糖尿病患者自我管理对糖尿病视网膜病变的影响

摘要

Objective To analyze the influence of diabetic patients' self-management behaviors on diabetic retinopathy(DR) in community,and to provide reference for the prevention and control of it's occurrence and development.Methods From January to June in 2015,658 patients were diagnosed as Type Ⅱ diabetes,who were randomly selected from a certain community resident's health management records.The research adopted single factor analysis,multiple factors logistic regression analysis to evaluate diet,sport,medicine self-management,blood glucose monitoring,foot-care and hyperglycemia/hypoglycemia in prevention for the influence on diabetic retinopathy.Results 156 cases patients with DR were diagnosed from 658 cases patients with Type Ⅱ diabetes,the incidence of DR was 23.71％ (156/658).Conclusion The incidence of DR was higher in a certain community,which was relative with some factors,such as educational level,family income,course of disease,insulin treatment,history of Type Ⅱ diabetes,SBP,FPG,HbA1 c.Diabetic patients' self-management behavior abilities were low,blood glucose monitoring and foot-care ability were especially low.Diet,sport,medicine self-management,blood glucose monitoring,foot-care were all closely relative with DR.Community medical workers should analyze from different dimensions of self-management behavior and point out the aspects that need to be strengthened,to provide reference for the prevention and control of DR.They should instruct diabetic patients to master skills of monitoring blood glucose and improve self-management behavior ability.It is suggested that the government cover the basic drug for blood glucose monitoring and control into medical insurance to relieve the patients' economic burden.%目的 分析糖尿病患者自我管理行为对糖尿病视网膜病变发生的影响,为预防控制社区糖尿病患者视网膜病变的发生发展提供参考.方法 2015年1-6月,从某社区居民健康管理档案中随机选取既往史或现病史被诊断为Ⅱ型糖尿病患者658例,采用单因素分析、多因素Logistic回归分析、自我行为量表(2-SCS)进行评估,按计分情况分为差、中等、良好三级.为了比较不同程度自我管理行为对糖尿病视网膜病变发生的影响,特设计得分指标进行分析,并分为差(得分指标＜60％)、中等(得分指标60％ ～ 80％)、良好(得分指标＞80％)3个等级标准,了解饮食自我管理、运动自我管理、用药自我管理、监测血糖、足部护理、预防与处理高低血糖等对糖尿病视网膜病变发生的影响.结果 658例Ⅱ型糖尿病患者中,发生糖尿病视网膜病变(DR) 156例,发生率23.71％ (156/658).结论 某社区糖尿病患者视网膜病变发生率较高,原因可能与文化程度、家庭人均月收入、病程、是否使用胰岛素治疗、Ⅱ型糖尿病家族史、收缩压、空腹血糖、糖化血红蛋白等因素相关;糖尿病患者自我管理行为能力较低,监测血糖、足部护理更是如此;饮食自我管理、运动自我管理、用药自我管理、监测血糖、足部护理均与糖尿病视网膜病变密切相关.社区医务工作人员应从不同维度分析患者自我管理行为,指出患者需要加强的方面,为预防和控制糖尿病视网膜病变提供参考;应指导糖尿病患者掌握血糖监测技能,提高自我管理行为能力,建议政府将血糖监测、控制血糖基本用药纳入医疗保险,以减轻患者经济负担.