摘要目的 探索建立家属以监管身份参与糖尿病教育管理的新模式.方法 建立以医生为总管理者、患者家属为督促者、患者为自我管理者、护士为施教者的MUST糖尿病管理模式,采用改良的Deborah糖尿病自我管理评价表进行依从性判定.对2010年6至7月收治的180例2型糖尿病患者采用区组随机的方法分为干预组和对照组(各90例)进行1年的观察.干预组男47例,女43例,平均年龄(52±12)岁,病程(10±3)年.对照组男46例,女44例,平均年龄(52±12)岁,病程(11±4)年.其中干预组进入MUST管理模式,对照组采用传统的糖尿病教育模式,分析比较两组依从性的改进情况.两组均数比较用配对或独立样本t检验,计数资料用卡方检验.结果 干预组患者完全从医行为观察结束时比观察开始时提高超过1倍(75.6％比34.4％,x2=30.01,P＜0.05),而且从进入MUST模式的第3个月依从性改善就有明显提高(67.8％比34.4％,x2=20.01,P＜0.05),半年后依从性改善维持高水平,直到观察结束,但在观察后期略有下降.从第3个月开始,完全从医人数干预组与同时期对照组比较差异均有统计学意义(均P＜0.01).对依从性五大分项的分析显示影响对照组依从性的主要因素是饮食和运动.两组观察结束后,合理的运动强度(OR=2.555,P=0.000)、胰岛素合理使用(OR =4.812,P=0.002)、低盐低脂饮食(OR=5.028,P=0.029)、合理血糖监测频率(OR=20.656,P=0.000)以及合理运动频率(OR=6.560,P=0.001)5个单项对依从性改善影响最大.结论 MUST模式强调家属作为监督者的身份参与糖尿病教育的重要性,可显著提高患者的依从性.

abstractsObjective To improve compliance of patients with type 2 diabetes mellitus with a new education mode involving the patients' family members.Methods Set up a diabetes education mode joined by the doctors (manager,M),the patients' family members(urger,U),the patients (self-manager,S)and the nurses ( teacher,T) (MUST).The improvement of compliance in 180 patients treated from June to July 2010 was evaluated with modified Deborah's diabetes knowledge and self-management skills self-evaluate table.The patients were divided block-randomly into intervention group and control group (90 patients in each group).There were 47 males and 43 females in intervention group with a mean age of (52 ± 12 )yrs and a disease-course of ( 10 ± 3) yrs ; there were 46 males and 44 females in control group with a mean age of (52 ± 12) yrs and a disease-course of ( 11 ± 4) yrs.The patients in intervention group were educated with MUST mode for 1 year,and meanwhile the patients in control group were educated in traditional education system.The compliance change of patients was compared between the two groups. The t test was used in paired- or indipendent-samples analysis and x2 test in counting variable.Results The good compliance in intervention group at the end of observation improved more than 1 time compared with that at the beginning (75.6％ vs 34.4％,P ＜0.01 ).This improvement was observed at the point of the 3rd month(67.8％,P ＜0.01 ) and kept in this high level to the end of the observation. From the 3rd month on,the good compliance in intervention group at each point of observation were statistically higher than those in control group ( all P ＜ 0.01 ). Diet and exercise were the barriers to compliance improvement in control group according to the analysis of the five sub-items of compliance.Advisable exercise intensity( OR =2.555,P =0.000),advisable use of insulin ( OR =4.812,P =0.002 ),low-salt and low-fat diet ( OR =5.028,P =0.029),advisable blood sugar monitoring frequency ( OR =20.656,P =0.000) and advisable exercise frequency ( OR =6.560,P =0.001 ) were the most 5 single items affected to compliance improvement in two groups.Conclusions The urger role of the family members of the type 2 diabetic patients is most important in the MUST educational system for these patient to improve the compliance reliably.