张引 徐学凡 刘怡

摘 要 目的：探索家庭医生在诊疗过程中对签约糖尿病患者实施血糖监测认知指导的效果。方法：家庭医生在诊疗中对555名社区签约糖尿病患者进行四项血糖监测知识的指导。每月1次，每次一项知识，每次3～5分钟，共6次；对指导前和完成6次指导后进行知识问卷测评。结果：指导后，知晓血糖监测四个单项知识的人数比例分别比指导前上升了23%、21.2%、22%和19.4%，差别有统计学意义（P<0.001）；知晓3项和知晓4项的比例分别上升了8.1%和21.4%，差别均具有统计学意义（P<0.001）；定期血糖监测人数较指导前提升了5.2%。结论：家庭医生在诊疗中对签约糖尿病患者实施血糖监测认知指导是可行的，对提高患者定期监测血糖认知和行为具有促进作用。

关键词 家庭医生；诊疗过程；血糖监测认知指导；效果

中图分类号：R587.1 文献标志码：A 文章编号：1006-1533（2018）24-0043-03

Effect of blood glucose monitoring cognition guidance for diabetic patients in family doctors diagnosis and treatment

ZHANG Yin， XU Xuefan， LIU Yi

（Public Health Department of Tianmuxilu Community Health Service Center of Jingan Distract， Shanghai 200070， China）

ABSTRACT Objective： To explore the effect of family doctors in the implementation of blood glucose monitoring cognitive guidance for the contracted diabetic patients in the diagnosis and treatment process. Methods： Family doctors conducted four blood glucose monitoring knowledge guidelines for 555 community contracted diabetic patients in the diagnosis and treatment. The knowledge guideline was conducted by the family doctors once a month， and one item of knowledge was for 3～5 minutes each time， a total of 6 times； knowledge questionnaire evaluation was conducted before and after the 6 guidance. Results： After the guidance： the proportion of people who knew the four items of individual knowledge of blood glucose monitoring increased by 23%， 21.2%， 22% and 19.4%， respectively compared to the previous guidance， and the differences were statistically significant（P<0.001）； the proportion of 3 items and 4 items increased by 8.1% and 21.4%， respectively， and the differences were statistically significant（P<0.001）； the number of people having regular blood glucose monitoring increased by 5.2% compared to the previous guidance. Conclusion： It is feasible for family doctors to implement cognitive guidance on blood glucose monitoring for the contracted diabetic patients in the diagnosis and treatment， which has a role in promoting the patients to improve their cognition of regular monitoring of blood glucose and behavior.

KEY WORDS family doctor； diagnosis and treatment process； cognitive guidance of blood glucose monitoring； effect

糖尿病是以血糖增高為主要临床特征，主要是胰岛素的绝对或相对不足或者靶细胞对胰岛素敏感性的下降。上海市35岁及以上居民糖尿病患病率为17.57%，患者血糖控制率仅25.34%[1]，大部分患者血糖未得到有效控制[2-4]。而血糖的有效控制可以显著降低糖尿病患者发生并发症的风险[5-7]。本研究旨在探索家庭医生诊疗时实施认知指导对糖尿病患者的定期血糖监测认知和行为的影响。

1 对象与方法

1.1 研究对象

以社區签约的2型糖尿病患者为研究对象，纳入要求：病程10年以下，无严重慢性病疾病（脑梗死、心脏病、肾病等），生活能自理，愿接受签约家庭医生糖尿病综合治疗管理。本研究共纳入2型糖尿病患者555名，平均年龄（63.60±7.29）岁；男性219名，占39.5%，女性336名，占60.5%；75.6%的患者参加职工医保；文化程度以初、高中为主，分别占48.2%和30%；家庭年收入以5～10万比例最高，为37.3%；家庭以2人共居为多，占52.8%。

1.2 指导方法

家庭医生在诊室对就诊的糖尿病患者进行血糖监测作用相关知识的认知教育，内容包括：（1）对有助于调整饮食方案的认知；……