沈德蕾 韩威威 王晓琴 梁会凤 李萍 裔昭兰 汪凌

摘 要 目的：探索以自行設计的笔记本为工具、以“PDCA循环”理论为基础的饮食干预对社区中老年2型糖尿病患者的影响。方法：收集2018年7-12月上海徐汇区枫林街道社区卫生服务中心家庭医生签约在管的272例2型糖尿病患者的信息，随机分为试验组和对照组各136例。因随访脱落等原因，最终试验组有118例，其中男性55例，女性63例，平均年龄为（58.91±3.24）岁；对照组有124例，其中男性56例，女性68例，平均年龄为（57.96±3.67）岁。试验组以自行设计的涉及患者个人基本信息的笔记本内容为基础，结合每1～2个月固定1次的患者集中活动，以“PDCA循环”模式对患者的不良饮食习惯进行干预。对照组则采用传统的门诊、家访、电话形式干预。两组干预均为18个月，评估干预前后两组的血糖和血脂等指标。结果：干预后试验组及对照组的腰臀比、体重指数、糖化血红蛋白、空腹血糖水平、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-c）都低于干预前，高密度脂蛋白胆固醇水平均高于干预前，差异均有统计学意义（P<0.05）。但干预后试验组的TC和LDL-c水平低于与对照组，差异均有统计学意义（P<0.05）。结论：以笔记本为工具的“CDPA循环”模式饮食干预改善血脂的效果优于传统随访方式。

关键词 糖尿病；饮食习惯；干预模式

中图分类号：R587.1 文献标志码：A 文章编号：1006-1533（2021）12-0059-04

The effect of the “CDPA cycle” mode with a notebook as a tool in the intervention of the eating habits of middle-aged and elderly diabetic patients in the community

SHEN Delei， HAN Weiwei， WANG Xiaoqin， LIANG Huifeng， LI Ping， YI Zhaolan， WANG Lin

（General Medicine of Fenglin Community Health Service Center of Xuhui District， Shanghai 200030， China）

ABSTRACT Objective： To explore the effect of self-designed notebook as a tool， based on the theory of “CDPA cycle”to intervene the eating habits of middle-aged and elderly patients with type 2 diabetes in the community. Methods： Two hundred and seventy-two confirmed type 2 diabetes patients contracted by family doctors in Fenglin Community Health Service Center， Xuhui District， Shanghai from July to December 2018 were collected and randomly divided into an experimental group and a control group with 136 cases each. Due to the lost in the follow up， the experimental group completed 118 cases， of which 55 were males and 63 were females， with average age of （58.91±3.24） years. While the control group completed 124 cases of which 56 were males and 68 were females， with average age of （57.96±3.67） years. . The experimental group was based on the selfdesigned notebook content involving the basic personal information of the patients， combined with the concentrated activities of the patients once a month or two months， and intervened the bad eating habits exposed by the patients in the “CDPA cycle” mode； the control group was intervened by traditional outpatient， home visit and telephone； both groups were intervened for 18 months. The levels of blood glucose and serum lipids were evaluated before and after the intervention. Results： After intervention， the levels of fasting blood glucose and glycosylated hemoglobin as well as WHR， BMI， TC， LDL-c were lower than those before intervention. The level of HDL-c in two groups after intervention were higher than those before intervention（P<0.05）. After intervention， the levels of TC and LDL-c in experiment group were lower than those in contro group. the difference was statistically significant（P<0.05）. Conclusion： The intervention of the eating habits using “CDPA cycle” mode based on the notebooks as a tool is more effective than traditional follow-up methods .

KEY WORDS diabetes； eating habit； intervention mode

饮食治疗作为糖尿病综合管理的主要干预措施之一，对糖尿病病情的控制有着十分重要的意义。而饮食治疗的有效落实与饮食教育密切相关[1-3]。目前对于社区糖尿病患者如何开展有关饮食教育的方法和模式存在教育形式单一，饮食内容和计量繁琐使患者不易理解，在实际操作过程中很难把控具体量化指标等问题[4]。……