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目的 观察基于微信平台的健康管理方案对超重和肥胖糖尿病高危人群的干预效果,为制订科学有效地减肥方案提供依据.方法 选择健康查体中筛查的超重和肥胖糖尿病高危者123例,用随机数字表法分为干预组62例,对照组61例.对照组采用传统健康大讲座的方法进行干预,每周讲课1次,连续3个月.干预组在对照组的基础上通过微课堂给予饮食和运动干预,将糖尿病知识重点和干预方案上传至微课堂学习平台,安排固定时间与患者进行在线学习交流,并完成随访服务.饮食干预方案采用低能量摄入疗法,将每日热量摄入减少15%~40%;运动干预方案选用有氧运动结合适当力量性训练.对两组干预对象进行为期1年的随访,观察两组患者教育参与度、饮食及运动依从性、体质指数(BMI)、体脂量、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)的变化,采用独立样本t检验和χ2检验分析两组的血脂、血糖和减重效果.结果 干预组干预期间教育参与度为81.0%(583/720),高于对照组的72.9%(516/708),差异有统计学意义(χ2=13.18,P<0.05);干预组摄入碳水化合物、蛋白质、脂肪、盐的合理比例分别为85.0%、70.0%、73.0%、75.0%,高于对照组的66.0%、47.6%、49.2%、52.5%,差异有统计学意义(χ2=5.76,6.24,7.34,6.50,P<0.05);每日有效运动时间比较,干预组(22.8±2.1)min,长于对照组(16.2±1.8)min,差异有统计学意义(t=18.33,P<0.01);干预组TC、TG、LDL-C、FBG分别为(4.9±0.4)、(1.5±0.2)、(2.7±0.3)、(4.9±0.6)mmol/L、BMI(24.3±2.8)kg/m2、体脂量(19.6±1.9)kg,低于对照组的(5.6±0.4)、(2.1±0.2)、(3.9±0.3)、(5.8± 0.6)mmol/L、(27.8±2.9)kg/m2、(22.6±2.1)kg,差异有统计学意义(t=9.54,15.93,22.56,8.54,6.72,8.22,P均<0.01);干预组减重和减脂有效率分别为65.0%和60.0%,高于对照组的35.6%和32.2%,差异有统计学意义(χ2=10.29,9.25,P<0.05).结论 基于微信平台的健康管理方案能够提高干预对象教育参与度、合理饮食与运动依从性,有效降低超重和肥胖糖尿病高危人群的体重、血脂和血糖水平.

Objective To determine the effects of a health management program based on WeChat platform of overweight and obese diabetic high-risk population and to provide the basis for developing a scientific and effective weight loss program. Methods A total of 123 overweight and obese diabetic cases were identified during health examinations and were randomly divided into intervention(n=62)and control (n=61)groups.In the control group,traditional health lectures once a week for 3 months were conducted.In the intervention group,based on the control group using a micro-classroom setting to give diet and exercise interventions, diabetes information and intervention programs were uploaded to the WeChat learning platform, arranged at a fixed time with the patient online learning exchange, and with complete follow-up services. Low-energy intake therapy was used for diet intervention program, the daily calorie intake decreased by 15% to 40%;aerobic exercise combined with appropriate strength training were used as part of the exercise intervention program.Both groups were followed up for 1 year,measuring the dietary,exercise compliance, body mass index (BMI), body fat, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG) levels. Blood lipids, blood glucose, and weight loss were analyzed using an independent sample t-test and χ2test. Results The difference in the educational participation rate between the intervention (81.0%, 583/720) and control (72.9%, (516/708) groups was statistically significant(χ2=13.18,P<0.05).The reasonable proportions of carbohydrate,protein, fat, and salt were 85.0%, 70.0%, 73.0%, and 75.0%, respectively, in the intervention group, which were significantly higher than those in the control group(66.0%,47.6%,49.2%,and 52.5 %,respectively),The difference was statistically significant(χ2=5.76,6.24,7.34,6.50,all P<0.05).To compare the daily effective exercise time,the intervention group(22.8±2.1)min was significantly longer than the control group(16.2± 1.8)min,with a statistically significant difference(t=18.33,P<0.01).The TC,TG,LDL-C,and FBG levels in the intervention group [(4.9 ± 0.4) mmol/L, (1.5 ± 0.2) mmol/L, (2.7 ± 0.3) mmol/L, and (4.9 ± 0.6) mmol/L, respectively]were significantly lower than those in the control group[(5.6±0.4)mmol/L,(2.1±0.2)mmol/L, (3.9±0.3)mmol/L,and(5.8±0.6)mmol/L,respectively].The BMI in the intervention group(24.3±2.8)kg/m2 was significantly lower than that in the control group(27.8±2.9)kg/m2.Moreover,the mean level of body fat in the intervention group (19.6 ± 1.9) kg was lower than that in the control group (22.6 ± 2.1) kg, with a statistically significant difference (t=9.54, 15.93, 22.56, 8.54, 6.72, 8.22, all P<0.01). The effective rate of weight loss and fat loss was 65.0% and 60.0% in the intervention group,which were significantly higher than those in the control group (35.6% and 32.2%, respectively), with a statistically significant difference (χ2=10.29, 9.25, all P<0.05). Conclusion The health management program based on a micro-letter platform can improve the participation in the intervention and reasonable diet and exercise compliance and effectively reduce the weight and blood lipid and glucose levels of overweight and obese diabetic patients.