自我管理模式在城市社区2型糖尿病管理中的应用及效果研究
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摘要
背景:2型糖尿病是终身性慢性疾病,一旦患病,不仅具有致死、致残性,还会给患者及家属带来沉重的精神压力和经济负担,严重影响患者家庭的生活质量。随着我国人口老龄化进程的加剧,特别是老年人口高龄化趋势日益明显,2型糖尿病的患病率有逐步上升的趋势,已经给社会和政府带来沉重的负担。国内外大量研究表明,以社区为基础,持续开展健康促进是预防和控制糖尿病的最佳策略。我国社区防治糖尿病起步较晚,现有的管理模式不能完全适应各层次2型糖尿病患者日常管理的需求,还需进一步开展管理模式的探索。本研究在吸收国外社区糖尿病自我管理模式成功经验的基础上,结合重庆市实际,在国内开展2型糖尿病患者自我管理模式城市社区应用的研究,以期探索一种更适合城市社区2型糖尿病患者日常管理需求的模式。
目的:通过比较两种不同管理模式对2型糖尿病患者日常管理的效果,对自我管理模式在社区2型糖尿病管理的作用和可行性进行论证。
方法:采取以社区为基础的人群干预试验,于2009年2月—2009年8月在重庆市沙坪坝区选取经济条件、人口学特征、卫生服务状况特征均能代表重庆城市社区卫生发展水平的2个卫生服务中心,再从选取的卫生服务中心中各随机抽取1个社区卫生站作为研究试点,通过居委会动员社区卫生站下辖社区中的2型糖尿病患者参加本次干预实验。本次试验共抽取104名2型糖尿病患者,按照所属社区卫生站随机分为实验组和对照组进行为期6个月的干预实验,实验组患者接受自我管理模式管理,对照组患者按照现行的重庆市社区2型糖尿病病例管理规范,接受分级分层管理模式管理。实验结束后,通过比较两组患者入组时、干预3个月、干预结束时,在糖尿病知识知晓率、自我管理水平、抑郁、焦虑状况以及血糖、血压、体重指数方面的变化情况并结合两种管理模式的干预成本及组织开展的管理活动,对自我管理模式的管理效果和可行性进行评价。
结果:1、自身前后对照:实验组患者干预3个月和干预6个月与干预前相比,患者糖尿病知识知晓率、自我管理水平均有明显提高(P<0.05),抑郁、焦虑症状得到明显的改善(P<0.05),空腹血糖、餐后2h血糖、糖化血红蛋白均值、收缩压均值、体重指数均值均显著下降(P<0.05),舒张压均值略有下降,但没有显著变化(P>0.05),空腹血糖、餐后2h血糖、糖化血红蛋白达标率、血压达标率均显著提高(P<0.05),体重指数达标率略有上升,实验组患者各项指标干预3个月和干预6个月相比较,空腹血糖均值和收缩压均值显著降低(P<0.05),其他指标变化均无统计学意义;对照组患者干预后3个月和6个月与干预前相比,糖尿病知识得分均值有显著提高(P<0.05),自我管理水平评分降低、抑郁、焦虑评分上升,但没有显著变化(P>0.05),空腹血糖、餐后2h血糖、糖化血红蛋白均值均显著下降,血压及体重指数略有降低,空腹血糖、餐后2h血糖、糖化血红蛋白达标率均显著提高(P<0.05),血压、体重指数达标率有所提高,对照组患者各项指标干预后3个月和6个月相比,除餐后2h血糖、糖化血红蛋白均值上升显著外,均无统计学意义(P>0.05)。
2、组间对照:实验组患者干预后3个月、6个月糖尿病知识水平知晓率、自我管理水平、以及空腹血糖、餐后2h血糖、糖化血红蛋白、血压、体重指数达标率均显著高于对照组患者(P<0.05),抑郁、焦虑症状改善情况也显著高于对照组患者(P<0.01),空腹血糖、餐后2h血糖、糖化血红蛋白均值均显著高于对照组患者;血压、体重指数均值与对照组患者无差异。
3、干预成本:实验组患者接受随访指导和心理疏导比对照组患者分别高出126和14人次,参加健康教育课程和小组活动分别比对照组患者高出542和578人次,干预成本比对照组患者每人每月增加16.2元。
结论:本次研究结果表明自我管理模式在提高城市社区2型糖尿病患者的糖尿病知识知晓率、自我管理水平、改善抑郁、焦虑症状和糖尿病控制方面优于分级分层管理模式,干预成本则增加有限。但由于本研究的局限性,自我管理模式是否能取代分级分层管理模式对社区2型糖尿病患者进行日常管理,还需结合该模式的长期效果和对社区不同人群的管理效果进一步分析讨论。
Background: Type 2 diabetes is a lifelong chronic disease, once the disease is not only lethal, debilitating, but also to the patients and their families a heavy mental stress and financial burden seriously affect the quality of life in patients with family. Along with the increase of population aging process, particularly the elderly population growing tendency to aging, the prevalence of type 2 diabetes has gradually rise, and the government has given the community a heavy burden. Many domestic and international research shows that community-based, ongoing health promotion is to prevent and control diabetes, the best strategy. Late start of community prevention and control diabetes, current management can not meet all levels of the daily management of type 2 diabetes needs, management needs to further exploration. In this study, absorption of foreign communities in diabetes self-management model based on the successful experience, combined with the practical in Chongqing, China carried out in patients with type 2 diabetes self-management model applied research in urban communities, to explore a more suitable urban community daily in patients with type 2 diabetes demand management modelObjective: to compare the two different management mode for patients with type 2 diabetes, explore the effect of Chongqing real diabetes management mode.
Objective: To compare two different management models on the daily management of patients with type 2 diabetes the effects of self-management of type 2 diabetes management in the community, the role and feasibility demonstration
Methods: To adopt a community-based field test group, in February 2009 -2 009 years in August Shapingba District in Chongqing City, selected economic conditions, demographic characteristics, health services in behalf of Chongqing urban communities through both the level of health development in the two health service centers, from the selected health service centers in the randomly selected one community health station as a research pilot, to mobilize the community through neighborhood health stations under the jurisdiction of the community in patients with type 2 diabetes to participate in this interference. The trial had taken 104 patients with type 2 diabetes, according to their community health stations were randomly divided into experimental and control group for 6-month intervention for the study, experimental group received self-management model management, control group patients according to the existing Chongqing Type 2 diabetes in community case management protocol, and received hierarchical management model management classification. End of the experiment, by comparing the two groups were enrolled, the intervention in 3 months, intervention at the end of knowledge in diabetes awareness, self-management level, depression, anxiety, and blood glucose, blood pressure, body mass index changes, and combine the two kind of management intervention in the management of costs and organize activities, self-management model to evaluate management effectiveness and feasibility.
Results: 1、Self controlled: experimental group intervention and intervention 3 months 6 months compared with before intervention, patients with diabetes knowledge were significantly increased level of self-management (P <0.05), depression and anxiety symptoms are obvious improved (P <0.05), fasting glucose, postprandial 2h plasma glucose and glycosylated hemoglobin mean, the mean systolic blood pressure, body mass index were significantly decreased the mean (P <0.05), mean diastolic blood pressure decreased slightly, but no significant change (P> 0.05 ), fasting glucose, postprandial 2h plasma glucose, glycated hemoglobin compliance rate, blood pressure and compliance were significantly increased (P <0.05), body mass index standard rate rose slightly in the experimental group were the target intervention and intervention 3 months 6 months compared with the mean fasting blood glucose and significantly lower mean systolic blood pressure (P <0.05), no significant changes in other indicators; control group of patients 3 months after intervention and 6 months compared with before intervention, the mean score of diabetes knowledge there significantly increased (P <0.05), self-management score lower, depression, anxiety score increased, but no significant change (P> 0.05), fasting glucose, postprandial 2h plasma glucose, glycated hemoglobin mean value was significantly decreased, blood pressure and body mass index slightly have lower fasting and 2h plasma glucose, glycated hemoglobin was significantly increased compliance (P <0.05), blood pressure, body mass index standard rate has increased, the control group after the intervention of the indicators in patients 3 months and 6 months compared ratio, in addition to 2h postprandial blood glucose, mean glycated hemoglobin increased significantly, the no statistical significance (P> 0.05).
2、Control groups: experimental group 3 months after the intervention, 6 months, the level of diabetes knowledge, awareness, self-management, as well as fasting and 2h plasma glucose, glycated hemoglobin, blood pressure, body mass index were significantly higher than compliance control group (P <0.05), depression, anxiety, improvement of symptoms was also significantly higher in patients (P <0.01), fasting and 2h plasma glucose, glycated hemoglobin were significantly higher than average patient; blood pressure, body weight index mean and the control group patients respectively.
3、The cost of intervention: experimental group received follow-up guidance and psychological counseling and higher than the control group were 126 and 14 times respectively, to participate in health education programs and group activities were higher than the control group were 542 and 578 passengers, the cost of intervention than the control group increase of 16.2 yuan per person per month in patients.
Conclusion: The results show that the self-management model in enhancing the urban communities of diabetes in patients with type 2 diabetes knowledge awareness, self-management level, improve depression, anxiety and diabetes control than hierarchical classification management, interventions to increase the cost of the limited . However, the limitations of this study, self-management model is to replace hierarchical classification of community management of patients with type 2 diabetes, daily management, the model needs to combine long-term effects and management on the effectiveness of different community groups and further discussed.
目的:通过比较两种不同管理模式对2型糖尿病患者日常管理的效果,对自我管理模式在社区2型糖尿病管理的作用和可行性进行论证。
方法:采取以社区为基础的人群干预试验,于2009年2月—2009年8月在重庆市沙坪坝区选取经济条件、人口学特征、卫生服务状况特征均能代表重庆城市社区卫生发展水平的2个卫生服务中心,再从选取的卫生服务中心中各随机抽取1个社区卫生站作为研究试点,通过居委会动员社区卫生站下辖社区中的2型糖尿病患者参加本次干预实验。本次试验共抽取104名2型糖尿病患者,按照所属社区卫生站随机分为实验组和对照组进行为期6个月的干预实验,实验组患者接受自我管理模式管理,对照组患者按照现行的重庆市社区2型糖尿病病例管理规范,接受分级分层管理模式管理。实验结束后,通过比较两组患者入组时、干预3个月、干预结束时,在糖尿病知识知晓率、自我管理水平、抑郁、焦虑状况以及血糖、血压、体重指数方面的变化情况并结合两种管理模式的干预成本及组织开展的管理活动,对自我管理模式的管理效果和可行性进行评价。
结果:1、自身前后对照:实验组患者干预3个月和干预6个月与干预前相比,患者糖尿病知识知晓率、自我管理水平均有明显提高(P<0.05),抑郁、焦虑症状得到明显的改善(P<0.05),空腹血糖、餐后2h血糖、糖化血红蛋白均值、收缩压均值、体重指数均值均显著下降(P<0.05),舒张压均值略有下降,但没有显著变化(P>0.05),空腹血糖、餐后2h血糖、糖化血红蛋白达标率、血压达标率均显著提高(P<0.05),体重指数达标率略有上升,实验组患者各项指标干预3个月和干预6个月相比较,空腹血糖均值和收缩压均值显著降低(P<0.05),其他指标变化均无统计学意义;对照组患者干预后3个月和6个月与干预前相比,糖尿病知识得分均值有显著提高(P<0.05),自我管理水平评分降低、抑郁、焦虑评分上升,但没有显著变化(P>0.05),空腹血糖、餐后2h血糖、糖化血红蛋白均值均显著下降,血压及体重指数略有降低,空腹血糖、餐后2h血糖、糖化血红蛋白达标率均显著提高(P<0.05),血压、体重指数达标率有所提高,对照组患者各项指标干预后3个月和6个月相比,除餐后2h血糖、糖化血红蛋白均值上升显著外,均无统计学意义(P>0.05)。
2、组间对照:实验组患者干预后3个月、6个月糖尿病知识水平知晓率、自我管理水平、以及空腹血糖、餐后2h血糖、糖化血红蛋白、血压、体重指数达标率均显著高于对照组患者(P<0.05),抑郁、焦虑症状改善情况也显著高于对照组患者(P<0.01),空腹血糖、餐后2h血糖、糖化血红蛋白均值均显著高于对照组患者;血压、体重指数均值与对照组患者无差异。
3、干预成本:实验组患者接受随访指导和心理疏导比对照组患者分别高出126和14人次,参加健康教育课程和小组活动分别比对照组患者高出542和578人次,干预成本比对照组患者每人每月增加16.2元。
结论:本次研究结果表明自我管理模式在提高城市社区2型糖尿病患者的糖尿病知识知晓率、自我管理水平、改善抑郁、焦虑症状和糖尿病控制方面优于分级分层管理模式,干预成本则增加有限。但由于本研究的局限性,自我管理模式是否能取代分级分层管理模式对社区2型糖尿病患者进行日常管理,还需结合该模式的长期效果和对社区不同人群的管理效果进一步分析讨论。
Background: Type 2 diabetes is a lifelong chronic disease, once the disease is not only lethal, debilitating, but also to the patients and their families a heavy mental stress and financial burden seriously affect the quality of life in patients with family. Along with the increase of population aging process, particularly the elderly population growing tendency to aging, the prevalence of type 2 diabetes has gradually rise, and the government has given the community a heavy burden. Many domestic and international research shows that community-based, ongoing health promotion is to prevent and control diabetes, the best strategy. Late start of community prevention and control diabetes, current management can not meet all levels of the daily management of type 2 diabetes needs, management needs to further exploration. In this study, absorption of foreign communities in diabetes self-management model based on the successful experience, combined with the practical in Chongqing, China carried out in patients with type 2 diabetes self-management model applied research in urban communities, to explore a more suitable urban community daily in patients with type 2 diabetes demand management modelObjective: to compare the two different management mode for patients with type 2 diabetes, explore the effect of Chongqing real diabetes management mode.
Objective: To compare two different management models on the daily management of patients with type 2 diabetes the effects of self-management of type 2 diabetes management in the community, the role and feasibility demonstration
Methods: To adopt a community-based field test group, in February 2009 -2 009 years in August Shapingba District in Chongqing City, selected economic conditions, demographic characteristics, health services in behalf of Chongqing urban communities through both the level of health development in the two health service centers, from the selected health service centers in the randomly selected one community health station as a research pilot, to mobilize the community through neighborhood health stations under the jurisdiction of the community in patients with type 2 diabetes to participate in this interference. The trial had taken 104 patients with type 2 diabetes, according to their community health stations were randomly divided into experimental and control group for 6-month intervention for the study, experimental group received self-management model management, control group patients according to the existing Chongqing Type 2 diabetes in community case management protocol, and received hierarchical management model management classification. End of the experiment, by comparing the two groups were enrolled, the intervention in 3 months, intervention at the end of knowledge in diabetes awareness, self-management level, depression, anxiety, and blood glucose, blood pressure, body mass index changes, and combine the two kind of management intervention in the management of costs and organize activities, self-management model to evaluate management effectiveness and feasibility.
Results: 1、Self controlled: experimental group intervention and intervention 3 months 6 months compared with before intervention, patients with diabetes knowledge were significantly increased level of self-management (P <0.05), depression and anxiety symptoms are obvious improved (P <0.05), fasting glucose, postprandial 2h plasma glucose and glycosylated hemoglobin mean, the mean systolic blood pressure, body mass index were significantly decreased the mean (P <0.05), mean diastolic blood pressure decreased slightly, but no significant change (P> 0.05 ), fasting glucose, postprandial 2h plasma glucose, glycated hemoglobin compliance rate, blood pressure and compliance were significantly increased (P <0.05), body mass index standard rate rose slightly in the experimental group were the target intervention and intervention 3 months 6 months compared with the mean fasting blood glucose and significantly lower mean systolic blood pressure (P <0.05), no significant changes in other indicators; control group of patients 3 months after intervention and 6 months compared with before intervention, the mean score of diabetes knowledge there significantly increased (P <0.05), self-management score lower, depression, anxiety score increased, but no significant change (P> 0.05), fasting glucose, postprandial 2h plasma glucose, glycated hemoglobin mean value was significantly decreased, blood pressure and body mass index slightly have lower fasting and 2h plasma glucose, glycated hemoglobin was significantly increased compliance (P <0.05), blood pressure, body mass index standard rate has increased, the control group after the intervention of the indicators in patients 3 months and 6 months compared ratio, in addition to 2h postprandial blood glucose, mean glycated hemoglobin increased significantly, the no statistical significance (P> 0.05).
2、Control groups: experimental group 3 months after the intervention, 6 months, the level of diabetes knowledge, awareness, self-management, as well as fasting and 2h plasma glucose, glycated hemoglobin, blood pressure, body mass index were significantly higher than compliance control group (P <0.05), depression, anxiety, improvement of symptoms was also significantly higher in patients (P <0.01), fasting and 2h plasma glucose, glycated hemoglobin were significantly higher than average patient; blood pressure, body weight index mean and the control group patients respectively.
3、The cost of intervention: experimental group received follow-up guidance and psychological counseling and higher than the control group were 126 and 14 times respectively, to participate in health education programs and group activities were higher than the control group were 542 and 578 passengers, the cost of intervention than the control group increase of 16.2 yuan per person per month in patients.
Conclusion: The results show that the self-management model in enhancing the urban communities of diabetes in patients with type 2 diabetes knowledge awareness, self-management level, improve depression, anxiety and diabetes control than hierarchical classification management, interventions to increase the cost of the limited . However, the limitations of this study, self-management model is to replace hierarchical classification of community management of patients with type 2 diabetes, daily management, the model needs to combine long-term effects and management on the effectiveness of different community groups and further discussed.
引文
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25.吴文源.焦虑自评量表[J].中国行为医学科学,2001,10(行为医学量表手册特刊):124-125
26.《中国2型糖尿病防治指南》(2007版):43
27.刘淮玉,唐毅,徐慧华,等.社区2型糖尿病营养干预的对比研究[J].中国公共卫生, 2002, 18: 685-688·
28.周海艳,王宝珠.社区非依赖型糖尿病人的健康教育及效果评价[J].中国初级卫生保健, 1998, 12 (7): 42·
29. Rubak SL,Mainz J,Rubak JM. Shared care--integrated cooperation across the sectorboundaries about patient’s course .Modern health care system cooperat [ J ] . Ugeskr-Laeger,2002,164(45):5256-5261.
30. Williams DR,Baxter HS,Airey CM,et al.Diabetes UK funded surveys of the structural provision of primary care diabetes servicesin the UK[J].Diabet-Med.2002,19(Suppl 4):21-26.
31. Eijkelberg IM,Mur-Veeman IM,Spreeuwenberg C,et al.Patient focus groups about nurse-led shared care for the chronically ill[J]Patient-Educ-Couns,2002,47(4):329-336.
32.骆宏,谢斌.自我管理模式及其在精神卫生服务中的应用[J].上海精神医学,2004,16(2):117-119.
33. Lorig KR,Holman H.Self-management education:History,definition,outcomes,and mechanisms[J].Ann Behav Med,2003,26(1):1-7.
34. Swerissen H , Belfrage J , Weeks A , et al.A randomised control trial of a self-management program for people with a chronic illness from Vietnamese,Chinese,Italian and Greek backgrounds[J].Patient Educ Couns,2006,64(1-3):360-368.
35.傅华.慢性病患者如何过上健康幸福的生活[M].上海:复旦大学出版社,2002:21-22.
36.刘鹏飞,汪涛,王宜芝.慢性疾病自我管理的研究进展[J].中华护理杂志,2006,41(4):354-356.
37. Harvey PW,Docherty BM.Sisyphus and self-management:the chronic condition self-management paradox[J].Aust Health Rev,2007,31(2):184-192.
38.毛向群,朱丽萍,黄丽红等.糖尿病自我管理方法在城乡社区运用的影响因素分析[J].中国初级卫生保健2006,20(12):31-33
39.张玲,石凯,伍亚舟等.重庆市社区居民代谢综合征相关危险因素分析[J].中国公共卫生2009,25(6):697--699
40.韩令力糖尿病健康管理效果评价.[D]
41.毛向群,朱丽萍,余平等.糖尿病自我管理方法教育模式效果评价[J].中国公共卫生,2007,23(11):1403-1404
42. Kenny CJ,Pierce M,McGerty S.A survey of diabetes care in general practice inNorthern Ireland[J].Ulster-Med-J,2002,71(1):10-16.
43. Bissell R,Fernando B,Scobie I,et al.Implementing real-time system interfaces to support the shared care of diabetes patients[J].Medinfo,2001,10(Pt 1):599-603.
44. hiou ST,Lin HD,Yu NC,et al.An initial assessment of the feasibility and effectiveness of implementing diabetes shared care system in Taiwan--some experiences from I-Lan County[J].Diabetes-Res-Clin-Pract,2001,54(Suppl 1):S67-73.
45.刘彦君,宋晓菲,王莉,等.2型糖尿病患者抑郁症患病情况的调查[J].中国糖尿病杂志,2004,12(2):123一125.
46. Ameriean Diabetes Assoeiation. Diagnosis and classifieation of diabetes mellitus [J]. Diabetes Care,2005,28SuPPll:37一42.
47.寿涓,陈茂芳,周月明,等.抑郁对社区老年糖尿病患者的影响分析[J].中国临床医学,2003,10(1):50一51.
48. Edege LE. Diabetes, Major Depression, and Functional Disability Among U.S Adults[J]. Diabetes Care ,2004,27(2):421-428.
49.贾静源,王洪波,王利清,等.北京市海淀区2型糖尿病患者社区综合干预效果评价[J].首都公共卫生,2009,3(2):77-79.
50. Glasgow RE,Davis CL,Funnell MM,et al.Implementing practical interventions to support chronic illness self-management[J].Jt Comm JQual Saf,2003,29(11):563-574.
51.焦淑芳,王瑜,庞星火,等.北京市居民糖尿病患病现况及影响因素[J].中华预防医学杂志,2005,39(增刊) :3-5
52.金爱平,马晓化.对老年糖尿病患者进行健康教育的效果分析[J].中国当代医学:护理版,2006,(01):61-62.
53.初玲华.糖尿病自我管理干预式教育的效果评价.大理学院学报. 2004,3(1):17.
54.贾芸,王君俏,滕香宇. 2型糖尿病患者心理健康水平与自我管理的相关性研究[J].上海护理,2004,04:53-55.
55.贾芸,王君俏,刘伟,Ⅱ型糖尿病患者自我管理水平及其相关因素的研究[J].解放军护理杂志.2005:22(7) :163-165.
56.贾芸滕香宇糖尿病患者自我管理健康教育现状与对策[J].护理管理杂志..2005:(2) :271-272.
57.刘秀荣,冯正平,刘智平,等.强化随访对糖尿病患者的影响[J] .重庆医学,2006,35(9):789-801.
58.鞠昌萍.不同健康教育方式对2型糖尿病患者教育效果的研究[D] .35
59.杨柯君,王敬丽,孙玮等.高血压自我管理模式与分级管理模式比较[J].上海预防医学杂志2005,17(8):368-370.
60.吕书红,周玮田,田本淳,等.社区高血压糖尿病自我管理对患者相关行为影响的研究[J].中国健康教育2005,21(9):647-650.
1. WHO: The World Health Report. World Health Organization, Geneva, 1998.
2.李立明,饶克勤,孔灵芝,等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志,2005(7):478-484
3. International Diabetes Federation. Diabetes Atlas, Second Edition. International Diabetes Federation, Brussels, 2003.
4. Cook S,Gerold K,Edidin D,Briars R.Increasing problem solving in adolescents with type 1 diabetes: the choice diabetes program[J].Diatetes-Educ.2002 Jan-Feb, 28(1): 115-124
5.黄昭穗,糖尿病教育现状与展望[J],东南国防医药,2003,5(5):392-394
6. Pan XR, Yang WY, Li GW, et .Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care,1997,20:1664-1669.
7. Funnell MM. A core curriculum for diabetes education[J]. Dlinois,1998:1-4
8. Edward V.A multidisciplinary approach to foot care in diabetes [J].Community-Nurse, 1998,4(2):53
9.刘奕男,黄俊,傅东波.上海市闵行区糖尿病管理模式探索[J].健康教育与健康促进2006(3):12-15
10.杨惠勤,付东波,莫东梅等.上海浦东慢性病自我管理项目实施效果评价研究[J].中国初级卫生保健,2002,16(7):17-20
11. Kenny CJ, Pierce M, Mc Gerty S. A survey of diabetes care in general practice in Northern Ireland[J].Ulster fed-J, 2002, 71(1):10-16.
12.张亮,乐虹,张翔等.农村双向转诊系统的探讨—目的、内容及方法[J].中国农村卫生事业管理,1999,19(9);22-23
2.李立明,饶克勤,孔灵芝,等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志,2005(7):478-484
3.包玉倩中华医学会糖尿病学分会第十二次全国学术会议纪要[J] J].中华内分泌代谢杂志,2009(1): 4
4. International Institute WHO collaborating center for the non-com-municable disease.The rising global burden of DM and its complication estimates and projections to the year 2010[J].Diabetes Med 1997,14(2)suppl5:35-48
5.张利,刘爱珍.1995～2004年我院慢性非传染性疾病收治情况分析[J].《右江民族医学院学报》,2006(4):649-650
6. Kenny CJ, Pierce M, Mc Gerty S. A survey of diabetes care in general practice in Northern Ireland[J].Ulster fed-J, 2002, 71(1):10-16.
7.吴凤兰,刘国宁,张明珠,等.糖耐量减低者饮食干预前后糖化低密度脂蛋白水平的变化[J].疾病控制杂志,2002,6(2):112-114.
8.杨惠勤,付东波,莫东梅等.上海浦东慢性病自我管理项目实施效果评价研究[J].中国初级卫生保健,2002,16(7):17-20
9. Funnell MM. A core curriculum for diabetes education[J]. Dlinois,1998:1-4
10. Edward V.A multidisciplinary approach to foot care in diabetes [J].Community-Nurse, 1998,4(2):53
11.刘淮玉,唐毅,徐慧华,等.社区2型糖尿病营养干预的对比研究[J].中国公共卫生, 2002, 18: 685-688.
12.刘奕男,黄俊,傅东波.上海市闵行区糖尿病管理模式探索[J].健康教育与健康促进2006(3):12-15
13.朱宇,胡肇衡,纪立农,等. 2型糖尿病分级分层管理的效果评价[J].中国糖尿病杂志,2009,17(8):324-325.
14.杨惠勤,付东波,莫东梅等.上海浦东慢性病自我管理项目实施效果评价研究[J].中国初级卫生保健,2002,16(7):17-20
15.仇义华,唐治贵,赵广德等.重庆永川市糖尿病患病率调查[J].职业卫生与病伤,2001(2):115
16.刘先锋;刘达伟;杨小伶等.重庆市糖尿病的分布及影响因素研究[J].预防医学情报杂志,2007(2):158-160
17.周海艳,王宝珠.社区非依赖型糖尿病人的健康教育及效果评价[J].中国初级卫生保健, 1998, 12 (7): 42.
18. WHO. Definition, diagnosis, and classification of diabetes mellitus and its complications. report of a WHO consultation. Part 1:Diagnosis and classification of diabetes mellitus〔S〕.Geneva:WHO,1999.
19.陈霭玲,张振露,廖志红,等.糖尿病患者自我管理水平和生存质量相关性研究[J]中国行为医学科学,2006,15(5):434一436.
20. Fitzgerald JT, Anderson RM, Funnell MM, et al.The reliability and validity of a brief Diabetes Knowledge Test[J] Diabetes Care,1998,21:706-710
21. Deborah J Sarah E. Russell E. The summary of diabetes self-care activities measure[J]Diabeteseare2000,23(7):943-950
22.潘杰,尚少梅,付利,等.老年2型糖尿病患者自我照顾行为与疾病控制状况调查[J].护理学杂志,2006,21(17):7-9.
23. Hogan P.Dall T. Nikolov P. American Diabetes Association,Economic costs of Diabetes mellitus in the US in 2002[J].Diabetes Care,2003,26:917-932
24.吴文源.抑郁自评量表[J].中国行为医学科学,2001,10(行为医学量表手册特刊):131-132
25.吴文源.焦虑自评量表[J].中国行为医学科学,2001,10(行为医学量表手册特刊):124-125
26.《中国2型糖尿病防治指南》(2007版):43
27.刘淮玉,唐毅,徐慧华,等.社区2型糖尿病营养干预的对比研究[J].中国公共卫生, 2002, 18: 685-688·
28.周海艳,王宝珠.社区非依赖型糖尿病人的健康教育及效果评价[J].中国初级卫生保健, 1998, 12 (7): 42·
29. Rubak SL,Mainz J,Rubak JM. Shared care--integrated cooperation across the sectorboundaries about patient’s course .Modern health care system cooperat [ J ] . Ugeskr-Laeger,2002,164(45):5256-5261.
30. Williams DR,Baxter HS,Airey CM,et al.Diabetes UK funded surveys of the structural provision of primary care diabetes servicesin the UK[J].Diabet-Med.2002,19(Suppl 4):21-26.
31. Eijkelberg IM,Mur-Veeman IM,Spreeuwenberg C,et al.Patient focus groups about nurse-led shared care for the chronically ill[J]Patient-Educ-Couns,2002,47(4):329-336.
32.骆宏,谢斌.自我管理模式及其在精神卫生服务中的应用[J].上海精神医学,2004,16(2):117-119.
33. Lorig KR,Holman H.Self-management education:History,definition,outcomes,and mechanisms[J].Ann Behav Med,2003,26(1):1-7.
34. Swerissen H , Belfrage J , Weeks A , et al.A randomised control trial of a self-management program for people with a chronic illness from Vietnamese,Chinese,Italian and Greek backgrounds[J].Patient Educ Couns,2006,64(1-3):360-368.
35.傅华.慢性病患者如何过上健康幸福的生活[M].上海:复旦大学出版社,2002:21-22.
36.刘鹏飞,汪涛,王宜芝.慢性疾病自我管理的研究进展[J].中华护理杂志,2006,41(4):354-356.
37. Harvey PW,Docherty BM.Sisyphus and self-management:the chronic condition self-management paradox[J].Aust Health Rev,2007,31(2):184-192.
38.毛向群,朱丽萍,黄丽红等.糖尿病自我管理方法在城乡社区运用的影响因素分析[J].中国初级卫生保健2006,20(12):31-33
39.张玲,石凯,伍亚舟等.重庆市社区居民代谢综合征相关危险因素分析[J].中国公共卫生2009,25(6):697--699
40.韩令力糖尿病健康管理效果评价.[D]
41.毛向群,朱丽萍,余平等.糖尿病自我管理方法教育模式效果评价[J].中国公共卫生,2007,23(11):1403-1404
42. Kenny CJ,Pierce M,McGerty S.A survey of diabetes care in general practice inNorthern Ireland[J].Ulster-Med-J,2002,71(1):10-16.
43. Bissell R,Fernando B,Scobie I,et al.Implementing real-time system interfaces to support the shared care of diabetes patients[J].Medinfo,2001,10(Pt 1):599-603.
44. hiou ST,Lin HD,Yu NC,et al.An initial assessment of the feasibility and effectiveness of implementing diabetes shared care system in Taiwan--some experiences from I-Lan County[J].Diabetes-Res-Clin-Pract,2001,54(Suppl 1):S67-73.
45.刘彦君,宋晓菲,王莉,等.2型糖尿病患者抑郁症患病情况的调查[J].中国糖尿病杂志,2004,12(2):123一125.
46. Ameriean Diabetes Assoeiation. Diagnosis and classifieation of diabetes mellitus [J]. Diabetes Care,2005,28SuPPll:37一42.
47.寿涓,陈茂芳,周月明,等.抑郁对社区老年糖尿病患者的影响分析[J].中国临床医学,2003,10(1):50一51.
48. Edege LE. Diabetes, Major Depression, and Functional Disability Among U.S Adults[J]. Diabetes Care ,2004,27(2):421-428.
49.贾静源,王洪波,王利清,等.北京市海淀区2型糖尿病患者社区综合干预效果评价[J].首都公共卫生,2009,3(2):77-79.
50. Glasgow RE,Davis CL,Funnell MM,et al.Implementing practical interventions to support chronic illness self-management[J].Jt Comm JQual Saf,2003,29(11):563-574.
51.焦淑芳,王瑜,庞星火,等.北京市居民糖尿病患病现况及影响因素[J].中华预防医学杂志,2005,39(增刊) :3-5
52.金爱平,马晓化.对老年糖尿病患者进行健康教育的效果分析[J].中国当代医学:护理版,2006,(01):61-62.
53.初玲华.糖尿病自我管理干预式教育的效果评价.大理学院学报. 2004,3(1):17.
54.贾芸,王君俏,滕香宇. 2型糖尿病患者心理健康水平与自我管理的相关性研究[J].上海护理,2004,04:53-55.
55.贾芸,王君俏,刘伟,Ⅱ型糖尿病患者自我管理水平及其相关因素的研究[J].解放军护理杂志.2005:22(7) :163-165.
56.贾芸滕香宇糖尿病患者自我管理健康教育现状与对策[J].护理管理杂志..2005:(2) :271-272.
57.刘秀荣,冯正平,刘智平,等.强化随访对糖尿病患者的影响[J] .重庆医学,2006,35(9):789-801.
58.鞠昌萍.不同健康教育方式对2型糖尿病患者教育效果的研究[D] .35
59.杨柯君,王敬丽,孙玮等.高血压自我管理模式与分级管理模式比较[J].上海预防医学杂志2005,17(8):368-370.
60.吕书红,周玮田,田本淳,等.社区高血压糖尿病自我管理对患者相关行为影响的研究[J].中国健康教育2005,21(9):647-650.
1. WHO: The World Health Report. World Health Organization, Geneva, 1998.
2.李立明,饶克勤,孔灵芝,等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志,2005(7):478-484
3. International Diabetes Federation. Diabetes Atlas, Second Edition. International Diabetes Federation, Brussels, 2003.
4. Cook S,Gerold K,Edidin D,Briars R.Increasing problem solving in adolescents with type 1 diabetes: the choice diabetes program[J].Diatetes-Educ.2002 Jan-Feb, 28(1): 115-124
5.黄昭穗,糖尿病教育现状与展望[J],东南国防医药,2003,5(5):392-394
6. Pan XR, Yang WY, Li GW, et .Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care,1997,20:1664-1669.
7. Funnell MM. A core curriculum for diabetes education[J]. Dlinois,1998:1-4
8. Edward V.A multidisciplinary approach to foot care in diabetes [J].Community-Nurse, 1998,4(2):53
9.刘奕男,黄俊,傅东波.上海市闵行区糖尿病管理模式探索[J].健康教育与健康促进2006(3):12-15
10.杨惠勤,付东波,莫东梅等.上海浦东慢性病自我管理项目实施效果评价研究[J].中国初级卫生保健,2002,16(7):17-20
11. Kenny CJ, Pierce M, Mc Gerty S. A survey of diabetes care in general practice in Northern Ireland[J].Ulster fed-J, 2002, 71(1):10-16.
12.张亮,乐虹,张翔等.农村双向转诊系统的探讨—目的、内容及方法[J].中国农村卫生事业管理,1999,19(9);22-23