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目的 探讨基于知信行模式的社区2型糖尿病患者管理的效果.方法 2010年6月至2011年12月,从杭州市米市巷街道的2型糖尿病患者中筛选出930例作为研究对象,按照所在社区进行分组,干预组494例,组照组436例.干预组采用知信行管理模式进行管理和健康干预,对照组采用一般社区糖尿病管理方法.采用t检验或x2检验比较管理后两组糖尿病患者的空腹血糖、餐后2h血糖、糖化血红蛋白(HbA1c)、血压、血脂、体质指数等各项指标变化,采用改良的密西根糖尿病知识测试问卷进行两组患者知识、态度、行为方式比较.结果 干预组与对照组患者相比,基线资料差异均无统计学意义,具有可比性(P均＞0.05).通过1年的知信行模式干预,干预组空腹血糖为(6.2±1.3)mmol/L,餐后2h血糖为(8.3±2.4)mmol/L,HbA1c为(6.1±1.2)％,均明显低于对照组,差异有统计学意义(t=4.306、4.523、4.926,P＜0.05).干预组较对照组在糖尿病相关知识知晓率方面,如饮食控制(86.03％)、坚持运动(82.19％)、药物治疗(85.63％)、定期检查(70.45％)、不良生活习惯改善(76.1 1％)、问卷测试认知度(88.46％)均好于对照组(56.88％、49.31％、62.61％、41.97％、52.06％、27.29％),差异有统计学意义(x2=141、154、105、109、92.4、408.6,P＜0.05).干预组生活行为方式改善率,如饮酒(14.17％)、超重(15.79％)、合理膳食(70.65％)及适量运动(68.83％)均高于对照组(27.98％、30.05％、52.06％、43.35％),差异有统计学意义(x2=16.814、16.409、60.955、91.553,P＜0.001).结论 基于知信行管理模式在社区糖尿病综合干预管理中是一种有效的方法,有利于提高糖尿病的管理效果.

Objective To discuss the effectiveness of knowledge-attitude-practice(KAP)-based health management on type 2 diabetes in community residents.Methods From June 2010 to December 2011,930 type 2 diabetes patients living in Mishi Lane Community were enrolled and assigned to the intervention group(n=494) and the control group(n=436).The KAP mode was used for the intervention group,and the routine management mode was applied to the control group.Fasting blood glucose(FBG),PBG2 h,HbAlc,blood pressure(BP),triglyceride(TG) and body mass index(BMI) were tested and recorded.Student's t test or Chi-square test was used for data analysis.Results Age(t=0.124,P＞0.05),gender(x2=2.0,P＞0.05) and other demographics showed no statistically significant difference between the two groups(all P＞0.05).After one-year KAP-based health management,HbA 1 c of the intervention group reduced to(6.1 ± 1.2)％,FBG and PBG2 h reduced by 1.7 and 3.23 mmol/L,respectively(t=4.926,P＜0.05; t=4.306,P＜0.05; t=4.523,P＜ 0.05).Diet,physical exercises,medication,regular inspection,unhealthy habits and questionare test awaveness of the intervention group were improved(86.03％,82.19％,85.63％,70.45％ 76.11％ and 88.46％,respectively.Drinking,dietary structure,overweight and physical exercises of the intervention group were also improved(14.17％,15.79％,70.65％ and 68.83％,respectively; all P＜0.001).Conclusion The KAPbased health management is proved to be effective in the control of community diabetic patients.