摘要目的:探讨家庭参与式个案管理结合互联网远程健康指导模式对体检首诊2型糖尿病患者自我管理行为及自我效能的影响，以期为糖尿病患者早期行血糖管理提供参考。方法:选取2017年10月至2018年6月在首都医科大学附属北京友谊医院体检首诊为2型糖尿病患者200例，按随机数字表法将其分为观察组与对照组，每组100例。对照组患者采用常规管理方法，观察组采用家庭参与式个案管理结合互联网模式护理方法。比较2组患者干预后血糖指标、自我管理水平、自我效能及基本知识的认知情况。结果:干预后，观察组患者空腹血糖、餐后2 h血糖及糖化血红蛋白分别为（6.52 ± 1.34）mmol/L、（8.24 ± 1.25）mmol/L、（6.35 ± 1.24）%，均低于对照组的（6.94 ± 1.45）mmol/L、（8.70 ± 1.40）mmol/L、（6.75 ± 1.18）%，差异有统计学意义（ t值为-2.127、-2.451、-2.337， P<0.05）；饮食自我管理水平分别为（22.58 ± 4.24）、（15.38 ± 2.45）、（13.23 ± 1.10）、（18.66 ± 1.15）、（19.56 ± 3.14）、（17.35 ± 1.87）分，均高于对照组的（18.56 ± 3.87）、（11.64 ± 2.82）、（11.26 ± 1.82）、（15.38 ± 2.49）、（15.82 ± 3.56）、（15.34 ± 2.14）分，差异有统计学意义（ t值为7.003~11.959， P<0.01）；干预后自我效能水平分别为（9.12 ± 0.45）、（8.56 ± 0.62）、（8.86 ± 0.72）、（8.46 ± 0.68）、（9.26 ± 0.39）、（8.76 ± 0.46）分，均高于对照组的（8.14 ± 0.82）、（7.14 ± 0.85）、（7.58 ± 0.93）、（7.16 ± 0.85）、（8.14 ± 0.42）、（7.48 ± 0.79）分，差异有统计学意义（ t值为10.477~19.541， P<0.01）；观察组患者基本知识的认知水平为（17.45 ± 2.48）分，高于对照组的（13.12 ± 3.14）分，差异有统计学意义（ t值为10.822， P<0.01）。 结论:家庭参与式个案管理结合互联网模式护理方法可显著提升2型糖尿病患者自我管理能力、自我效能及疾病认知情况，对改善患者血糖代谢指标具有积极作用。

abstractsObjective:To explore the influence of family participatory case management combined with the Internet remote health guidance model on the self-management behavior and self-efficacy of patients with type 2 diabetes who are first diagnosed in physical examination, in order to provide reference for early blood glucose management of diabetic.Methods:A total of 200 patients who were newly diagnosed as type 2 diabetes in Beijing Friendship Hospital Affiliated to Capital Medical University from October 2017 to June 2018 were selected and divided into observation group and control group according to the random number table method, with 100 cases in each group. Patients in the control group were treated with routine management methods, while patients in the observation group were treated with family participatory case management combined with internet nursing mode. The blood glucose index, self-management level, self-efficacy and cognition of basic knowledge were compared between the two groups after intervention.Results:After the intervention, the fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin in the observation group were (6.52±1.34) mmol/L, (8.24±1.25) mmol/L, (6.35±1.24)%, which were lower than those in the control group(6.94±1.45) mmol/L, (8.70±1.40) mmol/L, (6.75±1.18)%, the differences were statistically significant ( t values were -2.127, -2.451, -2.337, P<0.05); the scores of self-management of diet self-management, regular exercise, medication self-management, blood glucose monitoring, foot care, high and low blood glucose prevention and treatment in the observation group were (22.58±4.24), (15.38±2.45), (13.23±1.10), (18.66±1.15), (19.56±3.14), (17.35±1.87) points respectively, which were higher than those in the control group [(18.56±3.87), (11.64±2.82), (11.26±1.82), (15.38±2.49), (15.82±3.56), (15.34±2.14) points], the differences were statistically significant ( t values were 7.003-11.959, P<0.01); the scores of self-efficacy of emotion control, reasonable rest, pain and discomfort control, self-care, medication compliance management, health problems in the observation group were (9.12±0.45), (8.56±0.62), (8.86±0.72), (8.46±0.68), (9.26±0.39), (8.76±0.46) points respectively, which were higher than those in the control group [(8.14±0.82), (7.14±0.85), (7.58±0.93), (7.16±0.85), (8.14±0.42), (7.48±0.79) points], the differences were statistically significant( t values were 10.477-19.541, P<0.01). The cognitive level of basic knowledge in the observation group was (17.45±2.48) points, which was higher than (13.12±3.14) points in the control group, the differences was statistically significant ( t value was 10.822, P<0.01). Conclusions:Family participatory case management combined with the Internet-based nursing model can significantly improve the self-management ability, self-efficacy and disease awareness of type 2 diabetes patients, and have a positive effect on improving patients' blood glucose metabolism indicators.