摘要
目的：探讨社区开展运动干预和健康教育结合的综合干预对中老年糖尿病患者的效果,包括提高糖尿病相关知识,改善血糖、血脂、血压及糖尿病的相关危险因素。
方法：在天津市王顶堤社区,通过查阅健康档案方式,按WH01999年糖尿病诊断标准选取124名糖尿病患者,并随机分成综合干预组和对照组,每组62人。综合干预组实施为期6个月的运动干预和健康教育相结合的综合干预措施,对照组不实施任何干预措施。用SPSS for Windows 13.0软件包对两组人群干预前后的体力活动、血糖、血压、糖尿病相关危险因素及糖尿病知识、态度、行为的变化进行协方差和多元方差分析。
结果：
1干预提高体力活动水平。干预组糖尿病患者经综合干预后,总体力活动代谢当量(MET)平均增加了446.01±801.74MET/周,总步行代谢当量平均增加了375.90±199.72MET/周,二者与干预前相比在统计学上有显著性差异。
2干预提高糖尿病知识、态度、行为水平。六个月后干预组患者糖尿病知信行量表得分平均增加了6.16±3.57分；对照组患者得分平均增加了2.74±3.36分；二者与干预前相比差异均存在统计学意义。经协方差分析结果显示,干预组患者糖尿病知识、态度、行为的变化幅度大于对照组。
3干预改善糖代谢。经过6个月的综合干预后,干预组糖尿病患者空腹血糖平均下降了1.40±2.16 mmol/L,餐后血糖平均下降了1.39±2.99 mmol/L,二者与干预前相比均有统计学意义。
4干预降低糖尿病相关危险因素。干预后干预组糖尿病患者的高密度脂蛋白胆固醇升高,低密度脂蛋白胆固醇降低,腰臀比降低,体重指数平均下降了0.47±0.63 kg/m2,收缩压平均下降9.64±14.01mmHg,这些指标与干预前相比均有统计学意义。结论：本研究证明,运动干预和健康教育相结合的综合干预模式可积极有效控制糖尿病患者病情,预防或延缓糖尿病并发症的发生。以健步行这种方式进行的运动干预,其实施具有良好的可行性和安全性,适合社区中老年糖尿病患者开展。
Objective:The aim of this project was to investigate the effects of a community comprehensive intervention program which combined exercise intervention with health education on middle aged and the elderly diabetes patients. It includes improvement of diabetes knowledge, blood glucose, blood lipids, blood pressure and diabetes-related risk factors.
Methods:A randomized controlled community trial was conducted.130 diabetes patients were selected and randomly assigned to intervention group and control group. There were 65 diabetes patients each group. The intervention group was given exercise intervention with health education interventions for 6 months. The control group was not given any intervention. The changes of two groups'physical activity, blood glucose, blood pressure, diabetes-related risk factors and diabetes knowledge, attitude, behavior before and after intervention were analyzed using SSPS 13.0 software package carry out covariance and multivariate analysis of variance.
Result:
1 The results showed that intervention group's total physical activity MET on average increased by 446.01±801.74MET/week and total walking MET on average increased by 375.90±199.72MET/week after integrated intervention. Both of them had significant statistically difference when compared before and after intervention.
2 After 6 months, the intervention group's diabetes knowledge, attitude, behavior score increased by 6.16±3.57, and the control group's score increased by 2.74±3.36. Both of them had significant statistically difference when compared before and after intervention. The covariance analysis showed that intervention group's diabetes knowledge, attitude, behavior score increased more than control group.
3 The intervention group's average fasting serum glucose level reduced by1.40±2.16mmol/L over an 6-month integrated intervention. And the two-hour post pran-dial blood glucose fell by an average 1.39±2.99 mmol/L. Both of them had signify-cant statistically difference when compared before and after the intervention.
4 High-density lipoprotein cholesterol was increased and low-density lipoprotein cholesterol was decreased in intervention group. Also waist to hip ratio reduced and body mass index reduced by an average 0.47±0.63 kg/m2, systolic blood pressure decreased by 9.64±14.01mmHg. They all had significant statistically difference when compared before and after intervention.
Conclusion:Results of the study indicates that integrated intervention model in which exercise intervention combined with health education intervention can be active and effective in control of diabetes and its related risk factors in elderly diabetes patients. It can be prevent or delay diabetes from complications. Walking is appropriate for middle-aged and elderly diabetes patients as an exercise intervention, because it has good feasibility and safety.
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