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目的 探讨实施亲属微信随访对糖尿病视网膜病变(DR)患者知识认知度、行为改变、视力及血糖的影响.方法 2014年1月至2015年12月因2型糖尿病入住内分泌科≥60岁的DR患者107例,按就诊的先后顺序分为微信组53例,对照组54例.对照组给予一般健康教育,微信组在此基础上实施亲属微信随访,群发教育信息每周1次,包含糖尿病及DR知识2个主题,随访时间12个月.用DR防治知识调查问卷、行为改变问卷、空腹血糖、餐后2 h血糖、糖化血红蛋白的测定值及视力评价实施效果.采用卡方检验对比患者认知率,行为改变及视网膜病变分期等;采用t检验对比空腹血糖、餐后2 h血糖、糖化血红蛋白及视力情况.结果 对于以下DR认知知识:糖尿病可以出现的全身并发症类型、确诊糖尿病后,首次进行眼底检查的时间、预防早期DR患者失明的关键措施、血糖控制理想是否需要定期检查眼底、糖尿病眼部主要有哪些并发症、DR患者何时应做激光治疗、DR患者多久检查1次眼底、血糖的正常范围、DR的严重危害方面,微信组随访后认知率分别为88.7%、67.9%、56.6%、96.2%、79.2%、67.9%、69.8%、94.3%、75.5%;随访后微信组与对照组比较,(χ2依次为16.77、30.76、16.30、7.75、9.68、36.03、9.25、10.57、9.41,P均<0.01),差异有统计学意义;微信组随访前后比较(χ2依次为19.41、38.22、17.90、8.23、9.34、38.22、21.81、12.08、25.52,P均<0.01),差异有统计学意义;对于DR的危险因素的认知率微信组随访前24.5%,随访后43.4%,前后比较差异有统计学意义(χ2=4.21,P<0.05);随访后微信组与对照组比较,差异有统计学意义(χ2=5.33,P<0.05);空腹血糖、餐后2 h血糖、糖化血红蛋白微信组随访前分别为(13.18±4.46)mmol/L、(16.17±3.97)mmol/L、(10.18±2.76)%;微信组随访后分别为(8.45±2.26)mmol/L、(11.34±2.34)mmol/L、(7.83±1.40)%;随访后微信组与对照组比较,(t依次为-7.06、-7.30、-6.37,P均<0.01),差异有统计学意义,微信组随访前后比较(t依次为6.83、7.59、5.54,P均<0.01),差异有统计学意义.微信组随访前视力为0.68±0.18、随访后0.71±0.20;随访后两组患者视力比较、微信组随访前后比较,对照组随访前后比较(t依次为1.02、-1.10、0.57,P均>0.05),差异无统计学意义.随访后患者在平衡膳食、规律进食,少食多餐、运动前穿宽松衣服和鞋袜、每次运动30 min以上、每周检测血糖1次、运动前后检测血糖等多项行为改变方面两组比较(χ2依次为11.54、11.77、13.68、5.89、10.23、8.72,P均<0.05),差异有统计学意义;任何情况下勿自行停药、视网膜病变Ⅰ期及视网膜病变Ⅱ期及以上两组比较(χ2依次为1.20、0.01、0.01,P均>0.05),差异无统计学意义.结论 实施亲属微信随访能够提高≥60岁DR患者这一特殊群体的疾病知识认知度、促进健康行为,有效控制血糖.

Objective To investigate the effects of WeChat follow-up of relatives on knowledge cognition, change of behavior, visual acuity and blood glucose for diabetic retinopathy (DR) patients.Methods Totally 107 typeⅡdiabetic patients from January 2014 to December 2015 in the Department of Endocrinology were enrolled in the study, with the inclusion criteria of 60 years of age and older and diagnosed with diabetic retinopathy. Subjects were divided into the WeChat group (53 cases) and the control group (54 cases) based on the order of enrollment. The control group was given routine care and health education, while the WeChat group was given additional follow-up of relatives through WeChat with distribution of health education messages for the management of DM and DR once each week for 12 months. Questionnaires were used to collect information on patient's knowledge of DR prevention & treatment and behavior change, FBG, PBG, and HbA1c, and visual acuity were also collected to assess the effectiveness of the intervention. Chi-square test was used to compare the patients' cognitive rate, behavioral change and stage of retinopathy. The t-test was used to compare fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and visual acuity. Results Cognitive Knowledge change on DR were analyzed for the following questions:the time of the first fundus examination after diagnosis of diabetes and occurrence of systemic complications; what are key measures for prevention of early blindness in patients with DR;fundus checkup requirements while blood glucose control is ideal;types of major eye complications for diabetic patients; when laser treatment should be done for DR patients; how long apart should patients check the fundus;what is the normal range of blood glucose;and the types of server damages of DR;etc. The cognitive rates of WeChat group after follow-up were as follows 88.7%, 67.9%, 56.6%, 96.2%, 79.2%, 67.9%, 69.8%, 94.3%, 75.5%. WeChat group compared with the Control group after follow-up (χ2 values were 16.77, 30.76, 16.30, 7.75, 9.68, 36.03, 9.25, 10.57and 9.41, respectively, all P<0.01), the difference was statistically significant. The results of WeChat group before and after the follow-up were (χ2 values were 19.41, 38.22, 17.90, 8.23, 9.34, 38.22, 21.81, 12.08 and 25.52, respectively, all P<0.01), the difference was statistically significant. The cognitive rate for DR risk factors for the WeChat group was 24.5% before follow-up and 43.4%after follow-up;the after follow-up difference between WeChat group and the Control group was statistically significant (χ2=5.33, P<0.05). WeChat group before and after follow-up comparison (χ2=4.21, P<0.05) was also statistically significant. For values of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin, results of WeChat group before follow-up were as follows (13.18± 4.46) mmol/L, (16.17 ± 3.97) mmol/L, (10.18 ± 2.76)%;results of WeChat group after follow-up were (8.45 ± 2.26) mmol/L, (11.34 ± 2.34) mmol/L,(7.83 ± 1.40)% respectively. The after follow-up comparison between WeChat group and the Control group showed statistically significant differences (t values were-7.06,-7.30, and-6.37, respectively, all P<0.01). Within the WeChat group, before and after follow-up comparison were all significantly different (t values were 6.83, 7.59 and 5.54, respectively, all P<0.01). The vision of WeChat group before follow-up was 0.68 ± 0.18, after follow-up was 0.71 ± 0.20. There were no significant differences in the two groups after follow-up, before and after follow-up WeChat group, the Control group before and after follow-up about visual acuity comparison (t values were 1.02,-1.10, and 0.57, respectively, all P>0.05). The two groups of patients were compared in balanced diet, regular eating time, meal volume, wearing loose clothing and exercise shoes and socks before each exercise, exercising for more than 30 min, weekly checkup of blood glucose, blood sugar test before and after the exercise and other measurements of behavior changes were significantly different (χ2 values were 11.54, 11.77, 13.68, 5.89, 10.23 and 8.72, respectively, all P<0.01 or 0.05). There were no significant differences in self-withdrawal of medication and Retinopathy stageⅠand stageⅡpatients and between these two patient groups (χ2 values were 1.20, 0.01 and 0.01, respectively, all P>0.05). Conclusions The practice of WeChat follow-up of relatives can improve cognition ability for DR patients aged 60 years and older, it can promote the healthy behavior and the BG monitoring effectively.