运用授权理论对2型糖尿病、糖调节受损患者实施行为改变的研究
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摘要
背景:糖尿病是严重危害人类健康的疾病,尤其是2型糖尿病随着经济的发展而日趋增高,特别是在发展中国家日益明显。据统计全球的糖尿病人数由1985年的3亿人增长到2000年的14.3亿,估计到2010年达到22亿,到2025年达到30亿。2型糖尿病与不健康的生活方式有关,因此,改变糖尿病患者和糖调节受损人群的生活方式,使危险因素下降尤为重要。
1研究目的:
1.1在大规模健康查体的基础上,对空腹血糖在5.6～6.9mmol/L范围、且既往未诊断为T2DM的保健干部人群,进行复查明确诊断,达到一级预防的目的。
1.2对新诊断的糖调节受损(IGR)、2型糖尿病(T2DM)人群进行糖尿病授权教育(education for patient empowerment),取得生活方式改变,降低危险因素的目标。
1.3检测糖调节受损(IGR)、2型糖尿病(T2DM)以及正常糖耐量人群脂联素水平与糖尿病危险因素的相关性,糖尿病授权教育后,取得脂联素上升,血糖、血压、体重、体重指数、腰臀比等明显改善的效果。
2研究方法:
2.1对象:采用方便取样的方法,从2006年9月～11月济南市保健干部来济南市中心医院进行健康查体1500余人中,除外既往诊断T2DM者,按照2003年美国糖尿病协会(ADA)公布的IFG诊断标准为5.6mmol/L≤空腹血糖＜6.9mmol几,筛查出54人进行葡萄糖耐量、胰岛素、C肽释放实验,其中28例诊断为T2DM,男性27人,女性1人,年龄44岁～65岁,平均53.43±5.30岁,身高171.96±4.96 cm。26例诊断为糖调节受损(17例诊断为IGT,9例诊断为IFG),男性23人,女性3人,年龄42岁～66岁,平均54.93±6.09岁,身高171.82±5.67cm。
2.2方法:对54人应用糖尿病授权教育1年。授权教育的方法分解到5个步骤:明确问题、表达感情、设立目标、制定计划、评价结果,共设置5次以上课程。
2006年健康查体的内容为身高、体重、血压、腰围、臀围、空腹血糖、血脂(甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)、尿酸等。1年糖尿病授权教育前后,对54人和31例正常对照者(正常对照者为随机选取的健康保健干部体检者),应用酶联免疫吸附法(ELISA),进行了血清脂联素的测定。54人在2007年9～11月再次进行健康查体,查体内容与2006年一致,作为评价接受糖尿病授权教育的效果。
2.3统计学分析:所有数据均采用SAS 8.2统计软件进行数据分析。血糖血脂、脂联素浓度等非正态分布资料,经自然对数正态转化后再进行分析,计量资料以均数±标准差表示,根据目的不同分别进行t-检验、方差分析、x~2检验和Pearson相关系数分析,p＜0.05为显著性标准。
3结果
3.1从表1-1～4可以看出,在糖尿病授权教育前糖尿病组、糖调节受损组、正常组血清脂联素依次升高,三组间差异均有统计学意义(P＜0.0001)。糖尿病授权教育后一年后三组间比较,正常组和糖调节受损组高于糖尿病组(P=0.00131),正常组两年间差异无统计学意义(P＞0.05)。
3.2从表2-1～2可以看出,糖尿病授权教育前糖尿病组的脂联素与甘油三酯(TG)有中度负相关关系。糖尿病授权教育后糖尿病组、糖调节受损组两组的脂联素和体重、甘油三酯有低度负相关关系,和高密度脂蛋白胆固醇(HDL-C)有低度正相关关系。
3.3从表3-1～4可以看出,糖尿病授权教育后,糖调节受损组血糖、体重、BMI、收缩压、舒张压、腰围明显降低(P＜0.05),脂联素显著升高(P＜0.0001)。糖尿病组血糖、体重、BMI、尿酸、腰围、腰臀比明显降低(P＜0.05),脂联素升高(P＜0.0001)。
3.4从表4-1～4可以看出,糖调节受损组和糖尿病组血糖异常的情况明显下降(P＜0.0001)。高胆固醇血症的比例明显下降(P=0.0023)。高尿酸血症的比例明显下降(P=0.0114)。腰臀比超标的比例2007年比2006年下降(P=0.0348)
3.5从表5中可以看出,糖调节受损组和糖尿病组实施授权教育1年后,参加者填写“行为改变效果评价表”作为评价接受教育的效果,15个行为项目中有13项显著改善(P值＜0.05),差异有统计学意义。
4结论
4.1在大规模的健康查体基础上,按照2003年美国糖尿病协会(ADA)公布的IFG的诊断标准5.6mmol/L≤空腹血糖＜6.9mmol/L,实行积极的筛查,能显著提高糖调节受损、2型糖尿病的检出率,避免糖尿病的漏诊。
4.2实行授权教育,可主动纠正可控制的不健康生活方式,取得行为改变的目标。
4.3授权教育能够明显降低血糖、血压、体重、BMI、腰臀比等糖尿病危险因素,升高脂联素,能更好地逆转和改善糖尿病。
Backgrounds:
Diabetes mellitus is a kind of seriously harmful disease.The prevalence of this chronic metabolic disease is increasing with the economic development especially in developing countries.Globally,the figure for the people with diabetes is said to have risen from 30 million in 1985 to 143 million in 2000.It is estimated that in the year 2010 it will be 220 million and 300 million in 2025.As we know,type 2 diabetes mellitus(T2DM) is associated with inactive life style.So it is very important to change lifestyle and decrease the risk factors of diabetes.
Objective:
1、To recheck participants who's are 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L and have no previous diagnosis of diabetes on the basis of 1500 health check-up cadres in Jinan Central Hospital to clear diagnose and prevention timely.
2、The participants(IGR and DM) were given the course of education for patient empowerment during 1 year to change their lifestyle and decrease the risk factors of diabetes.
3、To find out the correlation between adiponectin levels and the risk factors of diabetes among people with T2DM、IGR and normal glucose tolerance.After the education for patient empowerment,adiponectin level rises,FBG,BMI,TG,BP,WHR improved obviously.
Object and Methods:
1.Objects
54 patients were selected out according to the IF6 diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres in Jinan Central Hospital from September to December in 2006 except the patients who had diabetes history to carry out the OGTT text,28 of them were diagnosed diabetes, of whom 27 were male and 1 was female with the average age 53.43±5.30, the average height 171.96±4.96 cm.26 of these 54 patients were diagnosed IGR(17 IGT and 9 IFG),of whom 23 male and 3 female with the average age 54.93±6.09 and the average height 171.82±5.67cm.All the 54 patients who were first diagnosed with diabetes and the IGT,IFG patients were give the course of education for patient empowerment.
2.Methods
The patient were given education for patient empowerment for 1 year and the courses are divided the five steps:identify the problems; explore feelings;set up goals;make plans;evaluate the results.All the steps are needed.
Height,weight,blood pressure,waist circumference,hip circumference,fasting blood glucose,blood lipids(TC,TG,HDL-C,and LDL-C)and uric acid were included in the items of health check-up in 2006. We used ELISA to measure the adiponectin of the 54 patients and 31 normal persons After and before the 1 year course.The 54 patients were rechecked from September to December in 2007 and the checking items were same as 2006.The result was used to evaluate the effect of the course.
3.Statistical analyses:
All data were analyzed by SAS 8.2 software.Before statistical analyses Skew variables(TG,FBG and Adiponectin) were transformed to normalize their distribution.The numerical data were expressed as mean±SD and analyzed by t-test analysis,Chi-squared test,x~2 test and Pearson according to different aims.A threshold for significance was set as P＜0.05.
Results:
1.From Table 1-1～4 show that before education for patient empowerment in 2006 there was statistic meaning for the difference among DM,IGR and NC group(p＜0.0001).From the comparing the three group after education for patient empowerment in 2007 could be seen Adiponectin concentrations of NC,IGR group were significantly higher than DM group(P=0.00131).
2.From Table 2-1～2 show that before education for patient empowerment the Adiponectin and TG in DM group had a moderate negative correlation. After education for patient empowerment Adiponectin in NC and IGR had a low negative correlation with weight and TG,and had a low positive correlation with HDL-C.
3.From Table 3-1～2 show that after 1 year education for patient empowerment there was evident improvement in FBG,systolic pressure,diastolic pressure,weight,BMI and WC between two years in IGR group(P＜0.05).There was evident improvement in Adiponectin between two years in IGR group(p＜0.0001).There was statistical difference of FBG, weight,BMI,UA,WC,WHR between two years in DM group(P＜0.05).There was statistical difference of Adiponectin between two years in DM group (p＜0.0001).
4.From Table 4-1～4 show that abnormal blood level in 2007 decreased significantly than in 2006.High TC ratio were evidently decreased(P= 0.0023).High UAratio were evidently decreased(P=0.0114).WHR ratio fell in 2007 than in 2006(P=0.0348).
5.From Table 5 show that after 1 year education for patient empowerment there were 13 items changed evidently among 15 behavior items.
Conclusions:
1.According to the IFG diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres,positive intervention can significantly improve the detection rate of the IGR and diabetes which can avoid undiagnosis of the diabetes.
2.The empowerment of diabetes education can correct the controlled unhealthy lifestyle initiatively and achieve the goal of behavior change.
3.FBG,BMI,TG,BP,WHR and other risk factors have been significantly improved.Adiponectin have been significantly risen.These factors could reverse and improve diabetes better.
1研究目的:
1.1在大规模健康查体的基础上,对空腹血糖在5.6～6.9mmol/L范围、且既往未诊断为T2DM的保健干部人群,进行复查明确诊断,达到一级预防的目的。
1.2对新诊断的糖调节受损(IGR)、2型糖尿病(T2DM)人群进行糖尿病授权教育(education for patient empowerment),取得生活方式改变,降低危险因素的目标。
1.3检测糖调节受损(IGR)、2型糖尿病(T2DM)以及正常糖耐量人群脂联素水平与糖尿病危险因素的相关性,糖尿病授权教育后,取得脂联素上升,血糖、血压、体重、体重指数、腰臀比等明显改善的效果。
2研究方法:
2.1对象:采用方便取样的方法,从2006年9月～11月济南市保健干部来济南市中心医院进行健康查体1500余人中,除外既往诊断T2DM者,按照2003年美国糖尿病协会(ADA)公布的IFG诊断标准为5.6mmol/L≤空腹血糖＜6.9mmol几,筛查出54人进行葡萄糖耐量、胰岛素、C肽释放实验,其中28例诊断为T2DM,男性27人,女性1人,年龄44岁～65岁,平均53.43±5.30岁,身高171.96±4.96 cm。26例诊断为糖调节受损(17例诊断为IGT,9例诊断为IFG),男性23人,女性3人,年龄42岁～66岁,平均54.93±6.09岁,身高171.82±5.67cm。
2.2方法:对54人应用糖尿病授权教育1年。授权教育的方法分解到5个步骤:明确问题、表达感情、设立目标、制定计划、评价结果,共设置5次以上课程。
2006年健康查体的内容为身高、体重、血压、腰围、臀围、空腹血糖、血脂(甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)、尿酸等。1年糖尿病授权教育前后,对54人和31例正常对照者(正常对照者为随机选取的健康保健干部体检者),应用酶联免疫吸附法(ELISA),进行了血清脂联素的测定。54人在2007年9～11月再次进行健康查体,查体内容与2006年一致,作为评价接受糖尿病授权教育的效果。
2.3统计学分析:所有数据均采用SAS 8.2统计软件进行数据分析。血糖血脂、脂联素浓度等非正态分布资料,经自然对数正态转化后再进行分析,计量资料以均数±标准差表示,根据目的不同分别进行t-检验、方差分析、x~2检验和Pearson相关系数分析,p＜0.05为显著性标准。
3结果
3.1从表1-1～4可以看出,在糖尿病授权教育前糖尿病组、糖调节受损组、正常组血清脂联素依次升高,三组间差异均有统计学意义(P＜0.0001)。糖尿病授权教育后一年后三组间比较,正常组和糖调节受损组高于糖尿病组(P=0.00131),正常组两年间差异无统计学意义(P＞0.05)。
3.2从表2-1～2可以看出,糖尿病授权教育前糖尿病组的脂联素与甘油三酯(TG)有中度负相关关系。糖尿病授权教育后糖尿病组、糖调节受损组两组的脂联素和体重、甘油三酯有低度负相关关系,和高密度脂蛋白胆固醇(HDL-C)有低度正相关关系。
3.3从表3-1～4可以看出,糖尿病授权教育后,糖调节受损组血糖、体重、BMI、收缩压、舒张压、腰围明显降低(P＜0.05),脂联素显著升高(P＜0.0001)。糖尿病组血糖、体重、BMI、尿酸、腰围、腰臀比明显降低(P＜0.05),脂联素升高(P＜0.0001)。
3.4从表4-1～4可以看出,糖调节受损组和糖尿病组血糖异常的情况明显下降(P＜0.0001)。高胆固醇血症的比例明显下降(P=0.0023)。高尿酸血症的比例明显下降(P=0.0114)。腰臀比超标的比例2007年比2006年下降(P=0.0348)
3.5从表5中可以看出,糖调节受损组和糖尿病组实施授权教育1年后,参加者填写“行为改变效果评价表”作为评价接受教育的效果,15个行为项目中有13项显著改善(P值＜0.05),差异有统计学意义。
4结论
4.1在大规模的健康查体基础上,按照2003年美国糖尿病协会(ADA)公布的IFG的诊断标准5.6mmol/L≤空腹血糖＜6.9mmol/L,实行积极的筛查,能显著提高糖调节受损、2型糖尿病的检出率,避免糖尿病的漏诊。
4.2实行授权教育,可主动纠正可控制的不健康生活方式,取得行为改变的目标。
4.3授权教育能够明显降低血糖、血压、体重、BMI、腰臀比等糖尿病危险因素,升高脂联素,能更好地逆转和改善糖尿病。
Backgrounds:
Diabetes mellitus is a kind of seriously harmful disease.The prevalence of this chronic metabolic disease is increasing with the economic development especially in developing countries.Globally,the figure for the people with diabetes is said to have risen from 30 million in 1985 to 143 million in 2000.It is estimated that in the year 2010 it will be 220 million and 300 million in 2025.As we know,type 2 diabetes mellitus(T2DM) is associated with inactive life style.So it is very important to change lifestyle and decrease the risk factors of diabetes.
Objective:
1、To recheck participants who's are 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L and have no previous diagnosis of diabetes on the basis of 1500 health check-up cadres in Jinan Central Hospital to clear diagnose and prevention timely.
2、The participants(IGR and DM) were given the course of education for patient empowerment during 1 year to change their lifestyle and decrease the risk factors of diabetes.
3、To find out the correlation between adiponectin levels and the risk factors of diabetes among people with T2DM、IGR and normal glucose tolerance.After the education for patient empowerment,adiponectin level rises,FBG,BMI,TG,BP,WHR improved obviously.
Object and Methods:
1.Objects
54 patients were selected out according to the IF6 diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres in Jinan Central Hospital from September to December in 2006 except the patients who had diabetes history to carry out the OGTT text,28 of them were diagnosed diabetes, of whom 27 were male and 1 was female with the average age 53.43±5.30, the average height 171.96±4.96 cm.26 of these 54 patients were diagnosed IGR(17 IGT and 9 IFG),of whom 23 male and 3 female with the average age 54.93±6.09 and the average height 171.82±5.67cm.All the 54 patients who were first diagnosed with diabetes and the IGT,IFG patients were give the course of education for patient empowerment.
2.Methods
The patient were given education for patient empowerment for 1 year and the courses are divided the five steps:identify the problems; explore feelings;set up goals;make plans;evaluate the results.All the steps are needed.
Height,weight,blood pressure,waist circumference,hip circumference,fasting blood glucose,blood lipids(TC,TG,HDL-C,and LDL-C)and uric acid were included in the items of health check-up in 2006. We used ELISA to measure the adiponectin of the 54 patients and 31 normal persons After and before the 1 year course.The 54 patients were rechecked from September to December in 2007 and the checking items were same as 2006.The result was used to evaluate the effect of the course.
3.Statistical analyses:
All data were analyzed by SAS 8.2 software.Before statistical analyses Skew variables(TG,FBG and Adiponectin) were transformed to normalize their distribution.The numerical data were expressed as mean±SD and analyzed by t-test analysis,Chi-squared test,x~2 test and Pearson according to different aims.A threshold for significance was set as P＜0.05.
Results:
1.From Table 1-1～4 show that before education for patient empowerment in 2006 there was statistic meaning for the difference among DM,IGR and NC group(p＜0.0001).From the comparing the three group after education for patient empowerment in 2007 could be seen Adiponectin concentrations of NC,IGR group were significantly higher than DM group(P=0.00131).
2.From Table 2-1～2 show that before education for patient empowerment the Adiponectin and TG in DM group had a moderate negative correlation. After education for patient empowerment Adiponectin in NC and IGR had a low negative correlation with weight and TG,and had a low positive correlation with HDL-C.
3.From Table 3-1～2 show that after 1 year education for patient empowerment there was evident improvement in FBG,systolic pressure,diastolic pressure,weight,BMI and WC between two years in IGR group(P＜0.05).There was evident improvement in Adiponectin between two years in IGR group(p＜0.0001).There was statistical difference of FBG, weight,BMI,UA,WC,WHR between two years in DM group(P＜0.05).There was statistical difference of Adiponectin between two years in DM group (p＜0.0001).
4.From Table 4-1～4 show that abnormal blood level in 2007 decreased significantly than in 2006.High TC ratio were evidently decreased(P= 0.0023).High UAratio were evidently decreased(P=0.0114).WHR ratio fell in 2007 than in 2006(P=0.0348).
5.From Table 5 show that after 1 year education for patient empowerment there were 13 items changed evidently among 15 behavior items.
Conclusions:
1.According to the IFG diagnosed criteria(2003,ADA) of 5.6mmol/L≤Fasting Blood Glucose(FBG)＜6.9mmol/L from 1500 health check-up cadres,positive intervention can significantly improve the detection rate of the IGR and diabetes which can avoid undiagnosis of the diabetes.
2.The empowerment of diabetes education can correct the controlled unhealthy lifestyle initiatively and achieve the goal of behavior change.
3.FBG,BMI,TG,BP,WHR and other risk factors have been significantly improved.Adiponectin have been significantly risen.These factors could reverse and improve diabetes better.
引文
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15.Bob Anderson,Martha Funnell.The Art of Empowerment.American Diabetes Association 2005:151-194.
16.Anderson RM.Patient empowerment and the traditional medical model:A case of irreconcilable differences.Diabetes Care,1995,18:412-415.
17.楼青青,徐玉斓,杨丽黎.阶段性改变模式在糖尿病患者行为改变中的应用.中华护理杂志,2007,42(5):420
18.Anderson RM,Fitzgerald JT,Gruppen LD,et al.The diabetes empowerment scale-short form(DES-SF).Diabetes Care,2003,26:1641-1643.
19.Anderson RM,Funnell MM,Butler PM,et al.Patient empowerment:results of a randomized controlled trial.Diabetes Care,1995,18:943-949.
20.Anderson RM,Funnell MM,Fitzgerald JT,et al.The diabetes empowerment scale:a measure of psychosocial self-efficacy.Diabetes Care,2000,23:739-743.
21.Barlow J,Wright C,Sheasby J,et al.Self-management approaches for people with chronic conditions:a review.Patient Educ Couns,2002,48:177-187.
22.Morrow IS.What I leamed from Rosa:a story of poverty and empowerment.Diabetes Educ,2002,28:750-754.
23.Norris SL,Engelgau MM,Narayan KM.Effectiveness of self-management training in type 2 diabetes:a systematic review of randomized controlled trials.Diabetes Care,2001,24:561-587.
24.Pibernik-Okanovic M,Prasek M,Poljicanin-Filipovic T,et al.Effects of an empowerment-based psychosocial intervention on quality of life and metabolic control in type 2 diabetic patients.Patient Educ Couns,2004,52:193-199.
25.Shiu AT,Wong RY,Thompson DR.Development of a reliable and valid Chinese version of the diabetes empowerment scale.Diabetes Care,2003,26:2817-2820.
26.王淑芳.脂联素脂肪组织表达及其基因多态性与糖尿病相关性研究.山东大学,2005:21.
27.陈洁莉,邱明才,樊继援.脂联素及其基因单链核苷酸多态性在正常糖耐量、糖耐量受损和2型糖尿病患者的作用研究,2005:19-20.
28.包柄楠.脂联素与2型糖尿病的相关研究.重庆医科大学,2004:23-30
29.杨成悌,李小平.脂联素的研究进展.医学综述,2004,10(7):403.
30.唐金凤,杨颖,汪启迪,等.血清脂联素水平与肥胖度的关系.中华内分泌代谢杂志,2003,19(3):166-168.
31.杨泽,郑宏,史晓红.超重、肥胖及其与糖尿病的患病风险分析.中华内分泌代谢杂志,2003,19(3):177-180.
32.李小平,杨成悌,张灵.高血压患者血清脂联素的研究.中华心血管病志,2004年,32(7):596-598.
33.杨轶文,陈焕芹,常静.老年代谢综合征患者血清脂联素水平及其影响因素分析.中国老年学杂志,2007,27(3):455.
34.赵向彤,潘优津,吴朝明,等.糖调节受损患者血清脂联素水平及其相关因素研究.中国慢性病预防与控制,2007,(1):40-41.
35.杨建梅,郭晓蕙,王虹.长期血糖及血脂的强化控制可改善2型糖尿病患者的低脂联素血症.中国糖尿病杂志,2007(5):296-297.
36.韩东,崔丽萍.不同方式的急性运动对肥胖女性脂联素、瘦素水平的影响.华南师范大学,2007:35-45.
37.宋晨,张钧.运动与脂联素的研究进展.体育大学学报,2007,30(5):660-661.
38.Marcell TJ,McAuley KA,Traustadottir T,et al.Exercise training is not associated with improved levels of C-reactive protein or adiponectin.Metabolism,2005,54(4):533-541.
39.Hulver MW,Zheng D,Tanner C J,et al.Adiponectin is not altered with exercise training despite enhancedinsulinaction.Am J Physiol Endocrinol Metab,2002,283(4):E861-865.
40.Ferguson MA,White L J,McCoy S,et al.Plasma adiponectin response to acute exercise in healthy subjects.Eur J Appl Physiol,2004,91(2-3):324-329.
41.Boudou P,Sobngwi E,Mauvais-Jarvis F,et al.Absence of exercise-induced variations in adiponectin levels despite.Decreased abdominal adiponectinsity and improved insulin sensitivity in type 2 diabetic.EurJEndocrinol,2003,149(5):421-424.
42.Ryan AS,Nicklas BJ,Berman DM,et al.Adiponectin levels do not change with moderate dietary induced weight loss and exercise in obesepostmenopausal women.Int J Obes Relat Metab Disord,2003,27(9):1066-1071.
43.Kraemer RR,Aboudehen KS,Carruth AK,et al.Adiponectin responses to continuous and progressively intense intermittent exercise.Med SciSports Exerc,2003,35(8):1320-1325.
44.Jurimae J,Purge P,Jurimae T.Adiponectin is altered after maximal exercise in highly trained male rowers.Eur J Appl Physiol,2005,93(4):502-505.
45.Kriketos AD,Gan SK,Poynten AM,et al.Exercise increases adiponectin levels and insulin sensitivity in humans.Diabetes Care,2004,27(2):629-630.
46.中国糖尿病防治指南编写组.中国糖尿病防治指南.2004:57
47.James P,Cynthia L,Ken W,et al.A population perspective on diabetes prevention.Diabetes Care,2003,26:1999-2004.
48.中国高血压防治指南修订委员会.中国高血压防治指南.2005年版全文.
49.徐成斌.对《中国成人血脂异常防治指南》的浅析.中华老年医学杂志,2006,25(12):935.
50.李丽,杨莉,廖然.成都地区体检人群指数调查分析.预防医学情报杂志.2001,17(4):241-242.
51.Jaana Lindstrom,Johan Eriksson,Anne Louheranta.The Finnish Diabetes Prevention Study(DPS).Diabetes Care,2003,26,(12) 3230.
52.Carole Mensing,Andrea Lasichak,Jackie Boucher,et al.National Standards for Diabetes Self-Management Education.Diabetes Care,2005,28:792-793.
53.Robertoe.E,Izquierdo,Joann Keams,et al.A Comparison of Diabetes Education Administered Through Telemedicine Versus in Person.Diabetes Care,2003,26:1002-1007.
54.Graham T,McMahon,Helen E,et al.Web-Based Care Management in Patients With Poorly Controlled Diabetes.Diabetes Care,2005,28:1624-1629.
55.Samuel Klein,NancyF.Sheard,Xavier Pi-Sunyer.Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes:Retionale and Strategies.Diabetes Care,2004,27,(8):2070.
56.Robert M Anderson,Martha Mitchell Funnell,Nugget Burkhart,et al.101 Tips for Behavior Change in Diabetes Education.American Diabetes Association 2002:6-51.
1.Unwin N,Shaw J Zimmet P,et al.糖耐量低减和空腹血糖受损的定义及干预的现状.中华内分泌代谢杂志,2003,19:附录1,1-8.
2.包柄楠.脂联素与2型糖尿病的相关研究.重庆医科大学,2004:23-30.
3.Bob Anderson,Martha Funnell.The Art of Empowerment.American Diabetes Association 2005:3-290.
4.唐金凤,杨颖,汪启迪等,血清脂联素水平与肥胖度的关系.中华内分泌代谢杂志,2003,19(3):166-168.
5.Arita Y,KiharaS,OuchiN,et al.Paradoxiael decrease of an adipose specific protein,adiponectin,in obesity.Biochem Biophys Res Commun,1999,257(1):79-83,
6.Yu JG,JavorschiS,JavorschiS,et al.rhe effect of thiazolidinediones on plasma adiponectin levels in normal,obese,and type 2 diabetic subjects.Diabetes,2002,51(10):2968-2974.
7.Kriketos AD,Gan SK,Poynten AM,et al.Exercise increases adiponectin levels and insulin sensitivity in humans[J].Diabetes Care,2004,27(2):629-630.
8.陈兴宝,唐玲.陈慧云,等.2型糖尿病并发症对患者治疗费用的影响评估.中国糖尿病杂志,2003,11:238-241.
9.American Diabetes Asociation.Eeonomic consequences Of diabetes mdlitusin 1997.Diabetes Care,1998,21:296-309.
10.Brown JB,Pedula KL,Bakst AW.The progressive cost Of complications in type 2diabetes mellitus.Arch INTERN Med,1999,159:1873-1880.
11.Gilmer TO,Conner PW.The cost to health plans of poor glycemic control.Diabetes Care,1997,20:1847-1853.
12.Catherine J.Tibbetts,.Diabetes Self-Management Education:A Saga of Angels and Demons.Diabetes Spectrum Volume 19,Number 1,2006:54-56.
13.Norris SL,Lau J,Smith S J,:Self-management education for adults with type 2diabetes:a meta-analysis of the effect on glycemic control.Diabetes Care 2002,25:1159-1171.
14.Lorig KR,Ritter PL,Laurent DD:Internet-based chronic disease self-management:a randomized trial.Med Care2006,44:964-971.
15.Jones H,Edwards L,Vallis M,et al.Changes in diabetes self-care behaviors make a difference in glycemic control:the diabetes stages of change (DiSC)study.Diabetes Care,2003,26:732-737.
16.Mensing C,Boucher J,Cypress M,et al.National standards for diabetes self-management education.Diabetes Care,28(Suppl.1) 2005:S72-S79.
17.Martha M.Funnell MM,Tammy L.Belinda P.et al.National Standards for Diabetes Self-Management Education[J].Diabetes Care,2008,28:S97-S102.
18.Davidson MB:Effect of nurse-directed diabetes care in a minority population.Diabetes Care,2003,26:2281-2287.
19.Tang TS,Gillard ML,Funnell MM,et al:Developing a new generation of ongoing diabetes self-management support interventions(DSMS):a preliminary report.Diabetes Educ,2005 31:91-97.
20.Funnell MM,Nwankwo R,Gillard ML,et al.:Implementing an empowerment-based diabetes self management education program. Diabetes Educ, 2005,31:53-61.
21. Schillinger D, Grumbach K, Piette J, et al.: Association of health literacy with diabetes out comes. JAMA 2000,288: 475-482.
22. Chew LD, Bradley KA, Boyko EJ: Brief questions to identify patients with in adequate health literacy. Family Medicine 2000, 36:588—594.
23. Norris SL, Engetgan MM, VenkatN, et al.: Effectiveness of self management training in type 2 diabetes: systematic review Of randomized controlled trials. Diabetes Care, 2001,24: 561-587.
24. Robertoe.E, Izquierdo , Joann Kearns, Paule Knudson, et al. A Comparison of Diabetes Education Administered Through Telemedicine Versus in Person Diabetes Care ,2003,26: 1002-1007.
25. Graham T. McMahon, Helen E. Gomes, Sara Hickson Hohne, et al. Web-Based Care Management in Patients With Poorly Controlled Diabetes. Diabetes Care ,2005,28: 1624-1629.
26. Jaana Lindstrom, Johan Eriksson, Anne Louheranta. The Finnish Diabetes Prevention Study(DPS). Diabetes Care ,2003,26,(12) 3230.
27. Anderson RM, Fitzgerald JT, Gruppen LD, et al. The diabetes empowerment scale-short form (DES-SF). Diabetes Care, 2003,26: 1641-1643.
28. Anderson RM, Funnell MM, Butler PM, et al. Patient empowerment: results of a randomized controlled trial. Diabetes Care, 1995,18: 943-949.
29. Anderson RM, Funnell MM, Fitzgerald JT, et al. The diabetes empowerment scale: a measure of psychosocial self-efficacy. Diabetes Care, 2000, 23: 739-743.
30. Barlow J, Wright C, Sheasby J, et al. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns, 2002, 48:177-187.
31. Morrow IS. What I learned from Rosa: a story of poverty and empowerment. Diabetes Educ, 2002, 28: 750-754.
32. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care, 2001, 24: 561-587.
33. Pibernik-Okanovic M, Prasek M, Poljicanin-Filipovic, et al. Effects of an empowerment-based psychosocial intervention on quality of life and metabolic control in type 2 diabetic patients. Patient Educ Couns, 2004, 52: 193-199.
34. Shiu AT, Wong RY, Thompson DR. Development of a reliable and valid Chinese version of the diabetes empowerment scale. Diabetes Care, 2003, 26: 2817-2820.
35. Funnell MM, Anderson RM: Patient empowerment:a look back, a look ahead.Diabetes Educ 2003,29:454-464.
2.杜群,石福彦,丁奇龙.空腹血糖受损、糖耐量受损人群2年自然转归及其影响因素的研究.中华内分泌代谢杂志,2004,20(3):226.
3.范丽凤,陆菊明,田慧.全程糖尿病教育模式的构建、组织与管理.现代理.2005,11(8):575.
4.刘玉兰.糖尿病教育临床路径对护士教育职能影响.实用糖尿病志.2008,4(1):49.
5.戴霞,包小娟,林健.糖尿病教育触摸屏临床应用效果观察.护理研究,2005,19(12):1050.
6.王彦.以病友会为载体开展糖尿病教育初探.辽宁实用糖尿病杂志,2004,12(6):26.
7.Funnell MM,Anderson RM:Patient empowerment:a look back,a look ahead.Diabetes Educ 2003,29:454-464.
8.Bob Anderson,Martha Funnell.The Art of Empowerment.American Diabetes Association 2005:3-290.
9.Funnell MM.Patient education for patient empowerment.Diabetolog Croat,2001,30:7-10.
10.Funnell MM.Patient empowerment.Crit Care Nurs Q,2004,7:201-204.
11.Funnell MM,Anderson RM.Empowerment and self-management education.Clin Diabetes,2004,22:123-127.
12.Funnell MM,Anderson RM.Patient empowerment:A look back,a look ahead.Diabetes Educ,2003,9:454-464.
13.Funnell MM,Nwankwo R,Gillard ML,et al.Implementing an empowerment-based diabetes self-management education program.Diabetes Educ,2005,31:53-61.
14.Anderson RM,Funnell MM.Compliance and adherence are dysfunctional concepts in diabetes care.Diabetes Educ,2000,26:597-604.
15.Bob Anderson,Martha Funnell.The Art of Empowerment.American Diabetes Association 2005:151-194.
16.Anderson RM.Patient empowerment and the traditional medical model:A case of irreconcilable differences.Diabetes Care,1995,18:412-415.
17.楼青青,徐玉斓,杨丽黎.阶段性改变模式在糖尿病患者行为改变中的应用.中华护理杂志,2007,42(5):420
18.Anderson RM,Fitzgerald JT,Gruppen LD,et al.The diabetes empowerment scale-short form(DES-SF).Diabetes Care,2003,26:1641-1643.
19.Anderson RM,Funnell MM,Butler PM,et al.Patient empowerment:results of a randomized controlled trial.Diabetes Care,1995,18:943-949.
20.Anderson RM,Funnell MM,Fitzgerald JT,et al.The diabetes empowerment scale:a measure of psychosocial self-efficacy.Diabetes Care,2000,23:739-743.
21.Barlow J,Wright C,Sheasby J,et al.Self-management approaches for people with chronic conditions:a review.Patient Educ Couns,2002,48:177-187.
22.Morrow IS.What I leamed from Rosa:a story of poverty and empowerment.Diabetes Educ,2002,28:750-754.
23.Norris SL,Engelgau MM,Narayan KM.Effectiveness of self-management training in type 2 diabetes:a systematic review of randomized controlled trials.Diabetes Care,2001,24:561-587.
24.Pibernik-Okanovic M,Prasek M,Poljicanin-Filipovic T,et al.Effects of an empowerment-based psychosocial intervention on quality of life and metabolic control in type 2 diabetic patients.Patient Educ Couns,2004,52:193-199.
25.Shiu AT,Wong RY,Thompson DR.Development of a reliable and valid Chinese version of the diabetes empowerment scale.Diabetes Care,2003,26:2817-2820.
26.王淑芳.脂联素脂肪组织表达及其基因多态性与糖尿病相关性研究.山东大学,2005:21.
27.陈洁莉,邱明才,樊继援.脂联素及其基因单链核苷酸多态性在正常糖耐量、糖耐量受损和2型糖尿病患者的作用研究,2005:19-20.
28.包柄楠.脂联素与2型糖尿病的相关研究.重庆医科大学,2004:23-30
29.杨成悌,李小平.脂联素的研究进展.医学综述,2004,10(7):403.
30.唐金凤,杨颖,汪启迪,等.血清脂联素水平与肥胖度的关系.中华内分泌代谢杂志,2003,19(3):166-168.
31.杨泽,郑宏,史晓红.超重、肥胖及其与糖尿病的患病风险分析.中华内分泌代谢杂志,2003,19(3):177-180.
32.李小平,杨成悌,张灵.高血压患者血清脂联素的研究.中华心血管病志,2004年,32(7):596-598.
33.杨轶文,陈焕芹,常静.老年代谢综合征患者血清脂联素水平及其影响因素分析.中国老年学杂志,2007,27(3):455.
34.赵向彤,潘优津,吴朝明,等.糖调节受损患者血清脂联素水平及其相关因素研究.中国慢性病预防与控制,2007,(1):40-41.
35.杨建梅,郭晓蕙,王虹.长期血糖及血脂的强化控制可改善2型糖尿病患者的低脂联素血症.中国糖尿病杂志,2007(5):296-297.
36.韩东,崔丽萍.不同方式的急性运动对肥胖女性脂联素、瘦素水平的影响.华南师范大学,2007:35-45.
37.宋晨,张钧.运动与脂联素的研究进展.体育大学学报,2007,30(5):660-661.
38.Marcell TJ,McAuley KA,Traustadottir T,et al.Exercise training is not associated with improved levels of C-reactive protein or adiponectin.Metabolism,2005,54(4):533-541.
39.Hulver MW,Zheng D,Tanner C J,et al.Adiponectin is not altered with exercise training despite enhancedinsulinaction.Am J Physiol Endocrinol Metab,2002,283(4):E861-865.
40.Ferguson MA,White L J,McCoy S,et al.Plasma adiponectin response to acute exercise in healthy subjects.Eur J Appl Physiol,2004,91(2-3):324-329.
41.Boudou P,Sobngwi E,Mauvais-Jarvis F,et al.Absence of exercise-induced variations in adiponectin levels despite.Decreased abdominal adiponectinsity and improved insulin sensitivity in type 2 diabetic.EurJEndocrinol,2003,149(5):421-424.
42.Ryan AS,Nicklas BJ,Berman DM,et al.Adiponectin levels do not change with moderate dietary induced weight loss and exercise in obesepostmenopausal women.Int J Obes Relat Metab Disord,2003,27(9):1066-1071.
43.Kraemer RR,Aboudehen KS,Carruth AK,et al.Adiponectin responses to continuous and progressively intense intermittent exercise.Med SciSports Exerc,2003,35(8):1320-1325.
44.Jurimae J,Purge P,Jurimae T.Adiponectin is altered after maximal exercise in highly trained male rowers.Eur J Appl Physiol,2005,93(4):502-505.
45.Kriketos AD,Gan SK,Poynten AM,et al.Exercise increases adiponectin levels and insulin sensitivity in humans.Diabetes Care,2004,27(2):629-630.
46.中国糖尿病防治指南编写组.中国糖尿病防治指南.2004:57
47.James P,Cynthia L,Ken W,et al.A population perspective on diabetes prevention.Diabetes Care,2003,26:1999-2004.
48.中国高血压防治指南修订委员会.中国高血压防治指南.2005年版全文.
49.徐成斌.对《中国成人血脂异常防治指南》的浅析.中华老年医学杂志,2006,25(12):935.
50.李丽,杨莉,廖然.成都地区体检人群指数调查分析.预防医学情报杂志.2001,17(4):241-242.
51.Jaana Lindstrom,Johan Eriksson,Anne Louheranta.The Finnish Diabetes Prevention Study(DPS).Diabetes Care,2003,26,(12) 3230.
52.Carole Mensing,Andrea Lasichak,Jackie Boucher,et al.National Standards for Diabetes Self-Management Education.Diabetes Care,2005,28:792-793.
53.Robertoe.E,Izquierdo,Joann Keams,et al.A Comparison of Diabetes Education Administered Through Telemedicine Versus in Person.Diabetes Care,2003,26:1002-1007.
54.Graham T,McMahon,Helen E,et al.Web-Based Care Management in Patients With Poorly Controlled Diabetes.Diabetes Care,2005,28:1624-1629.
55.Samuel Klein,NancyF.Sheard,Xavier Pi-Sunyer.Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes:Retionale and Strategies.Diabetes Care,2004,27,(8):2070.
56.Robert M Anderson,Martha Mitchell Funnell,Nugget Burkhart,et al.101 Tips for Behavior Change in Diabetes Education.American Diabetes Association 2002:6-51.
1.Unwin N,Shaw J Zimmet P,et al.糖耐量低减和空腹血糖受损的定义及干预的现状.中华内分泌代谢杂志,2003,19:附录1,1-8.
2.包柄楠.脂联素与2型糖尿病的相关研究.重庆医科大学,2004:23-30.
3.Bob Anderson,Martha Funnell.The Art of Empowerment.American Diabetes Association 2005:3-290.
4.唐金凤,杨颖,汪启迪等,血清脂联素水平与肥胖度的关系.中华内分泌代谢杂志,2003,19(3):166-168.
5.Arita Y,KiharaS,OuchiN,et al.Paradoxiael decrease of an adipose specific protein,adiponectin,in obesity.Biochem Biophys Res Commun,1999,257(1):79-83,
6.Yu JG,JavorschiS,JavorschiS,et al.rhe effect of thiazolidinediones on plasma adiponectin levels in normal,obese,and type 2 diabetic subjects.Diabetes,2002,51(10):2968-2974.
7.Kriketos AD,Gan SK,Poynten AM,et al.Exercise increases adiponectin levels and insulin sensitivity in humans[J].Diabetes Care,2004,27(2):629-630.
8.陈兴宝,唐玲.陈慧云,等.2型糖尿病并发症对患者治疗费用的影响评估.中国糖尿病杂志,2003,11:238-241.
9.American Diabetes Asociation.Eeonomic consequences Of diabetes mdlitusin 1997.Diabetes Care,1998,21:296-309.
10.Brown JB,Pedula KL,Bakst AW.The progressive cost Of complications in type 2diabetes mellitus.Arch INTERN Med,1999,159:1873-1880.
11.Gilmer TO,Conner PW.The cost to health plans of poor glycemic control.Diabetes Care,1997,20:1847-1853.
12.Catherine J.Tibbetts,.Diabetes Self-Management Education:A Saga of Angels and Demons.Diabetes Spectrum Volume 19,Number 1,2006:54-56.
13.Norris SL,Lau J,Smith S J,:Self-management education for adults with type 2diabetes:a meta-analysis of the effect on glycemic control.Diabetes Care 2002,25:1159-1171.
14.Lorig KR,Ritter PL,Laurent DD:Internet-based chronic disease self-management:a randomized trial.Med Care2006,44:964-971.
15.Jones H,Edwards L,Vallis M,et al.Changes in diabetes self-care behaviors make a difference in glycemic control:the diabetes stages of change (DiSC)study.Diabetes Care,2003,26:732-737.
16.Mensing C,Boucher J,Cypress M,et al.National standards for diabetes self-management education.Diabetes Care,28(Suppl.1) 2005:S72-S79.
17.Martha M.Funnell MM,Tammy L.Belinda P.et al.National Standards for Diabetes Self-Management Education[J].Diabetes Care,2008,28:S97-S102.
18.Davidson MB:Effect of nurse-directed diabetes care in a minority population.Diabetes Care,2003,26:2281-2287.
19.Tang TS,Gillard ML,Funnell MM,et al:Developing a new generation of ongoing diabetes self-management support interventions(DSMS):a preliminary report.Diabetes Educ,2005 31:91-97.
20.Funnell MM,Nwankwo R,Gillard ML,et al.:Implementing an empowerment-based diabetes self management education program. Diabetes Educ, 2005,31:53-61.
21. Schillinger D, Grumbach K, Piette J, et al.: Association of health literacy with diabetes out comes. JAMA 2000,288: 475-482.
22. Chew LD, Bradley KA, Boyko EJ: Brief questions to identify patients with in adequate health literacy. Family Medicine 2000, 36:588—594.
23. Norris SL, Engetgan MM, VenkatN, et al.: Effectiveness of self management training in type 2 diabetes: systematic review Of randomized controlled trials. Diabetes Care, 2001,24: 561-587.
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