社区营养师指导下的糖尿病健康教育及个体化营养治疗为主的健康管理效果评价

发布时间：2018-05-03 22:07

本文选题：糖尿病 + 健康教育　；参考：《宁夏医科大学》2016年硕士论文

【摘要】：目的通过对2型糖尿病患者进行健康教育、个体化营养治疗及谷膳粉的食用干预效果评价,培养患者养成良好的饮食习惯和自我调整饮食的技能,为社区糖尿病控制流程中的营养干预和教育提供理论依据。方法在银川市80个社区中选取3个配合度高的社区,在社区内以自愿为原则选择240例T2DM患者作为研究对象,采用营养软件评估患者营养状况并测量血糖等生化指标评价患者血糖控制现状。采用析因设计方法,在群体健康教育基础上对患者采用个体化营养治疗和(或)食用谷膳粉。干预80天后评价干预效果对患者血糖、糖化血红蛋白等指标控制情况。结果社区中老年2型糖尿病患者自我管理水平平均为(3.27±1.15)分,管理水平一般者占总人数的61.9%,而自我管理水平较高的患者仅占总人数7.6%;240例患者的糖尿病相关知识知晓率为49.65%,一般知识和营养物质均衡的知识知晓率较高分别为:59.85%和65.45%,而食物交换法、总能量控制和血糖指数等方面知识知晓率较低为24.68%、36.67%和37.04%;血糖控制方面,240例患者空腹血糖患者控制率为37.5%,而糖化血红蛋白的控制率仅为26.3%。患者的年龄(OR=0.952)、家族史(OR=1.917)、病程(OR=1.870)和自我管理行为评分(OR=0.54)等都会影响对糖化血红蛋白的控制;患者的能量、蛋白质、钙、锌、维生素和膳食纤维等营养素的摄入量均低于推荐摄入量(RNI)的值(P0.05),胆固醇和铁的摄入量接近RNI值,患者的各种营养素摄入不足;240例患者干预后总体患者空腹血糖均值较干预前有所降低(P0.05),但患者的空腹血糖的控制率干预前后差异无统计学意义(P0.05)。四个不同干预组干预后糖化血红蛋白组间存在差异(P0.05);交互作用分析,个体化营养治疗对患者的空腹血糖中有明显的治疗作用(P0.05),单独食用谷膳无明显的治疗作用(P0.05),且两者之间不存在交互效应(P0.05);干预后糖尿病患者的糖化血红蛋白均值较干预前有明显降低(P0.05),且干预后患者糖化血红蛋白控制率为48.5%高于干预前的控制率26.3%(P0.05),食用谷膳粉对糖化血红蛋白无明显的治疗作用(P0.05),个体化的营养治疗可有效的改善患者的糖化血红蛋白(P0.05),且两者之间存在交互作用(P0.05),个体营养治疗措施下食用谷膳粉可以更好地提高患者的糖化血红蛋白控制情况。结论T2DM患者自我管理状况一般,血糖监测管理状况较低;患者对糖尿病相关知识有一定程度的了解,但营养治疗的专业知识认知较低;糖尿病患者干预前膳食结构不合理;糖尿病患者糖化血红蛋白的控制率较低,并受患者年龄、家族史、病程和SDSCA评分等因素的影响;以社区为基础营养师参与的个体化营养治疗干预方法对控制患者血糖和糖化血红蛋白有重要作用,食用谷膳粉与个体化营养治疗相结合可以提高患者的糖化血红蛋白的控制情况,可以为社区综合防治糖尿病提供参考依据。
[Abstract]:Objective to train the patients with type 2 diabetes mellitus by carrying out health education, individualized nutrition therapy and the evaluation of the effect of food intervention of cereal meal powder, so as to train the patients to develop good eating habits and self-adjust diet skills. To provide theoretical basis for nutrition intervention and education in community diabetes control process. Methods three out of 80 communities in Yinchuan City were selected and 240 patients with T2DM were selected as subjects. Nutritional software was used to evaluate the nutritional status of patients and biochemical indexes such as blood glucose were measured to evaluate the status of blood glucose control. On the basis of group health education, patients were treated with individualized nutrition and / or cereal meal powder by factorial design. After 80 days of intervention, the effect of intervention on blood sugar, glycosylated hemoglobin and other indicators were evaluated. Results the average self-management level of the middle-aged and elderly patients with type 2 diabetes mellitus in the community was 3.27 卤1.15). Those with average management level accounted for 61.9% of the total, while those with higher level of self-management accounted for only 7.66% of the total. The awareness rate of diabetes related knowledge of 240 patients was 49.65%, and the awareness rate of general knowledge and nutrition balance was 59.85%, respectively. And 65.45, and the method of food exchange, The awareness rate of total energy control and blood glucose index was lower than that of 24.68% and 37.04%, while the control rate of 240 patients with fasting blood glucose was 37.5%, while the control rate of glycosylated hemoglobin was only 26.3%. The age of the patients was 0.952, the family history was 1.917, the course of disease was 1.870) and the self-management behavior score was 0.54). The intake of nutrients such as vitamins and dietary fiber was lower than that of the recommended intake (P 0.05), and the intake of cholesterol and iron was close to RNI. The mean of fasting blood glucose in 240 patients was lower than that before intervention, but there was no significant difference in the control rate of fasting blood glucose between the two groups before and after intervention. There was significant difference in glycosylated hemoglobin between four different intervention groups (P0.05A). The effect of individualized nutrition therapy on fasting blood glucose of patients with diabetes mellitus was significant (P0.05N), and no significant therapeutic effect was found in eating cereal meal alone, and there was no interaction between the two. The mean value of glycosylated hemoglobin in patients with diabetes mellitus after intervention The control rate of glycosylated hemoglobin in patients after intervention was 48.5% higher than that before intervention, and there was no obvious therapeutic effect on glycosylated hemoglobin by eating cereal meal powder. The individualized nutritional therapy was effective. In order to improve the glycosylated hemoglobin (P0.05N) and the interaction between the two, the gluten meal powder can be used to improve the control of glycosylated hemoglobin (HbA1C) in the patients. Conclusion the self-management status of T2DM patients is general, the blood glucose monitoring management is low, the patients have a certain degree of understanding of diabetes related knowledge, but the knowledge of nutrition treatment is low, the dietary structure of diabetes patients before intervention is unreasonable. The control rate of glycosylated hemoglobin in diabetic patients was lower and was affected by age, family history, course of disease and SDSCA score. The intervention of individualized nutrition therapy with community based dietitian plays an important role in controlling patients' blood sugar and glycosylated hemoglobin. The combination of edible cereal meal powder and individualized nutrition therapy can improve the control of glycosylated hemoglobin in patients and provide reference for community comprehensive prevention and treatment of diabetes mellitus.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.1

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