
社区护士微信随访在2型糖尿病患者自我管理能力中的应用效果评价
Evaluation of application effect of WeChat follow-up of community nurses on self-management ability of patients with type 2 diabetes mellitus
目的:评价社区护士微信随访对2型糖尿病患者自我管理能力的应用效果。方法:选取华泾镇社区建档的100例糖尿病患者为研究对象,将研究对象分为观察组及对照组各50例,观察组中男性28例,女性22例,平均年龄(55.6±3.2)岁;对照组中男性27例,女性23例,平均年龄(55.2±3.3)岁。对对照组患者实施常规护理管理,对观察组患者实施微信群糖尿病护理管理,比较两组患者的血糖水平和自我管理评分。结果:干预前两组血糖指标的差异均无统计学意义(均P>0.05);干预后,观察组空腹血糖、餐后2h血糖和糖化血红蛋白值均低于对照组,差异均有统计学意义(均P<0.05)。干预后,观察组在饮食管理、运动管理、足部护理以及依从性(血糖监测、用药管理、吸烟)评分等方面均优于对照组,差异均具统计学差异(均P<0.05)。结论:社区护士通过微信建群和随访的方式信息沟通,可帮助患者按时按量服用降糖的药物,保持必要的运动量和合理的饮食,加强血糖自我监测,积极地控制好血糖。
Objective: To evaluate the application effect of WeChat follow-up of community nurses on self-management ability of patients with type 2 diabetes. Methods: One hundred cases of diabetic patients whose files were established in this community were selected as the research objects, and divided into an observation group and a control group with 50 cases each and in the observation group there were 28 males and 22 females and the average age was (55.6±3.2) years; in the control group there were 27 males and 23 females, and the average age was (55.2±3.3) years. The control group implemented the routine nursing care and the observation group implemented WeChat group diabetes nursing care management, and blood sugar level and the self-management scores of the patients in two groups were compared. Results: Before nursing management, the differences in blood glucose indicators were not statistically significant between the two groups(P>0.05); after the intervention, the fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin in the observation group were lower than those in the control group, and the differences were statistically significant(P>0.05). After intervention, the observation group was superior to the control group in diet management, exercise management, foot care and compliance(blood sugar monitoring, medication management, smoking) scores, and the differences were statistically significant(P<0.05).Conclusion: Through communicating information with WeChat group building and follow-up, the community nurses can help patients take hypoglycemic drugs on time and in quantity, keep necessary exercise, eat rationally, strengthen self-monitoring, and actively control their blood sugar level.
2型糖尿病 / 社区微信随访 / 血糖 / 自我管理能力 {{custom_keyword}} /
type 2 diabetes / community WeChat follow-up / blood sugar / self-management ability {{custom_keyword}} /
表1 两组患者护理管理前后的血糖指标比较 ( |
组别 | 空腹血糖/(mmol/L) | 餐后2 h血糖/(mmol/L) | 糖化血红蛋白/% | |||||
---|---|---|---|---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | 干预前 | 干预后 | |||
对照组 | 8.33±1.12 | 7.40±1.02 | 12.35±1.68 | 10.26±2.05 | 8.54±0.77 | 8.67±1.47 | ||
观察组 | 8.36±1.22 | 5.80±0.88 | 12.41±1.78 | 8.35±1.20 | 8.47±0.82 | 5.56±0.82 | ||
t值 | 0.227 | 5.936 | 0.272 | 4.558 | 0.223 | 6.175 | ||
P值 | >0.05 | <0.001 | >0.05 | <0.05 | >0.05 | <0.001 |
表2 两组患者自我管理评分对比 ( |
分组 | 饮食管理 | 运动管理 | 足部护理 | 依从性 |
---|---|---|---|---|
观察组 | 4.75±2.23 | 4.92±2.11 | 4.81±2.09 | 3.75±1.43 |
对照组 | 3.56±2.66 | 3.29±2.13 | 3.46±2.09 | 3.01±1.01 |
t值 | 4.019 | 4.258 | 4.372 | 4.887 |
P值 | <0.05 | <0.05 | <0.05 | <0.05 |
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The incidence of diabetes has been rising worldwide and is expected to increase to affect 591.9 million people by 2035 in China. Strict control of blood glucose can significantly reduce the risk of diabetic complications, but traditional interventions lack continuity, timeliness and teleonomy. The development of mobile health management has become a hot topic, as a very popular app in China, WeChat platform, has a large number of users every day. Many studies show the health management of patients with diabetes through WeChat can achieve the ideal effect. This study aims to evaluate the application of WeChat based on clinical research data, provide clinical evidence for medical staff and promote the self-management of patients with diabetes.The PubMed, EMBASE, Cochrane Library, CNKI and Wanfang database were searched to identify related reports that were published up to 9 March 2020. The quality of included studies was assessed by Cochrane Collaboration risk assessment tool. Measures of interest were mean difference (MD) and 95% confidence interval (CI). Random-effect model was used according to the absence or presence of significant heterogeneity. Heterogeneity among trials was evaluated by I test. Publication bias was assessed by funnel plots.Thirty-eight articles involved 2,709 controls and 2,709 patients who used WeChat were identified. Relative to the traditional group, WeChat group had a lower level in fasting plasma glucose (FPG in mmol/L; MD: 1.36, 95% CI 1.10-1.62, P < .00001), so did 2hPG (MD: 1.91, 95% CI 1.48-2.35, P < .00001) and HbA1C (MD: 1.07, 95% CI 0.86-1.27, P < .00001). Self-efficacy scale improved significantly, including diet score (MD: -1.31, 95% CI -1.77 to -0.86, P < .00001), exercise score (MD: -1.92, 95% CI -2.44 to -1.40, P < .00001), medication taking score (MD: -1.45, 95% CI: -1.94 to -0.97, P < .00001), monitoring of blood glucose score (MD: -1.17, 95% CI -1.83--0.51, P = .0005) and foot care score (MD: -1.71, 95% CI -2.08 to -1.34, P < .00001). Patients' understanding of the disease and satisfaction with follow-up increased significantly, whereas the incidence of adverse reactions and complications decreased.WeChat follow-up appears to be helpful to improve the level of blood glucose and self-management, reduce the incidence of adverse reactions and complications, and improve the satisfaction rate of patients with type 2 diabetes. It should be noted that this meta-analysis has limitations, such as small sample sizes and the low quality of included literature, as well as the lack of research in Western countries. Therefore, more high-quality studies with larger samples are needed in the future to verify our results.© 2020 John Wiley & Sons Ltd.
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目的 评价连续血糖监测(continuous glucose monitoring,CGM)与常规护理或自我血糖监测(self-monitoring of blood glucose,SMBG)相比,不同使用时长对糖尿病患者血糖控制的效果。 方法 检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中有关CGM对糖尿病患者糖化血红蛋白(HbA1c)、血糖高于范围时间(time above range,TAR)、目标血糖范围内时间(time in range,TIR)、血糖低于范围时间(time below range,TBR)和平均葡萄糖水平(mean glucose,MG)干预效果的随机对照试验,检索时限为建库至2021年8月。由2名研究者独立进行文献筛选、资料提取、文献质量评价后,采用RevMan 5.4及Stata 16软件进行Meta分析。 结果 共纳入11篇文献,包括1 745例糖尿病患者。糖尿病患者使用CGM>16周[MD=-0.23,95%CI(-0.35,-0.11),P<0.001]及≤16周[MD=-0.40,95%CI(-0.42,-0.38),P<0.001]对HbAlc水平,使用CGM>16周[MD=91.53,95%CI(65.77,117.28),P<0.001]及≤16周[MD=128.68,95%CI(112.95,144.42),P<0.001]对TIR,使用CGM>16周[MD=-45.10,95%CI(-76.34,-13.87),P=0.005]及≤16周[MD=-80.37,95%CI(-96.05,-64.69),P<0.001]对TAR,使用CGM>16周[MD=-31.83,95%CI(-44.11,-19.54),P<0.001]及≤16周[MD=-20.90,95%CI(-37.45,-4.35),P=0.010]对TBR,使用CGM≤16周对MG[MD=-0.40,95%CI(-0.54,-0.26),P<0.001]的影响,差异有统计学意义;使用CGM>16周对MG的影响,差异无统计学意义[MD=-0.22,95%CI(-0.48,0.04),P=0.090]。 结论 CGM不同使用时长均能够降低糖尿病患者的HbA1c,升高TIR并降低TBR、TAR,改善血糖控制。随着时长的增加,TBR的改善更为明显,HbA1c、TIR、TAR、MG的改善效果逐渐降低,MG改善长期效果不显著,仍需要更多高质量的研究进一步论证。
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