中国全科医学 ›› 2023, Vol. 26 ›› Issue (01): 74-81.DOI: 10.12114/j.issn.1007-9572.2022.0417

所属专题: 老年问题最新文章合集

• 论著·临床实践与改进研究 • 上一篇    下一篇

OTO模式对社区老年2型糖尿病患者血糖控制水平及自我管理行为能力的影响

王雪1,*(), 聂恒卓2, 刘海平3   

  1. 1.110847 辽宁省沈阳市,辽宁中医药大学护理学院
    2.110167 辽宁省沈阳市,辽宁中医药大学杏林学院
    3.110003 辽宁省沈阳市,北部战区总医院和平分院
  • 收稿日期:2022-06-14 修回日期:2022-09-24 出版日期:2023-01-05 发布日期:2022-10-28
  • 通讯作者: 王雪
  • 王雪,聂恒卓,刘海平. OTO模式对社区老年2型糖尿病患者血糖控制水平及自我管理行为能力的影响[J].中国全科医学,2023,26(1):74-81.[www.chinagp.net]
    作者贡献:王雪负责文章的构思与设计、数据收集与整理、结果解释和文章撰写;聂恒卓负责数据收集和文章的修订;王雪、刘海平负责文章的可行性分析,文章的质量控制及审校,并对文章整体负责。
  • 基金资助:
    2022年度沈阳市哲学社会科学规划课题(编号SY202207Y)

Influence of Online-to-offline Model on Glycemic Control and Self-management Behaviors in Older Type 2 Diabetics in the Community

WANG Xue1,*(), NIE Hengzhuo2, LIU Haiping3   

  1. 1.School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
    2.Xinglin College of Liaoning University of Traditional Chinese Medicine, Shenyang 110167, China
    3.General Hospital of Northern Theater Command, Shenyang 110003, China
  • Received:2022-06-14 Revised:2022-09-24 Published:2023-01-05 Online:2022-10-28
  • Contact: WANG Xue
  • About author:
    WANG X, NIE H Z, LIU H P. Influence of online-to-offline model on glycemic control and self-management behaviors in older type 2 diabetics in the community [J] . Chinese General Practice, 2023, 26 (1) : 74-81.

摘要: 背景 近年来,信息化管理模式被广泛应用于慢性病患者健康管理。作为国内外常见的"互联网+"慢性病管理模式,整合线上与线下资源的OTO(online-to-offline)模式已由治疗向预防转移,且已被证明可为慢性病管理提供有效支撑。目前国内鲜有OTO模式在老年糖尿病患者中的应用研究。 目的 探讨OTO模式对社区老年2型糖尿病患者血糖控制水平及自我管理行为能力的影响。 方法 于2020年8—10月,采用便利抽样法,选取从沈阳市某三级甲等医院转介至本市5家社区的老年2型糖尿病患者110例为研究对象,采用随机数字表法按照1∶1的比例将其随机分为对照组(n=55)和干预组(n=55),对其进行为期12个月的干预。对照组给予常规健康管理干预,干预组给予OTO模式健康管理干预。比较两组患者干预前及干预第6个月和12个月的空腹血糖(FBG)、餐后2 h血糖(2 h-PBG)和糖化血红蛋白(HbA1c)水平;比较两组患者干预前后的中文版自我管理行为量表(SDSCA)总得分及各维度得分。 结果 最终完成本次研究的患者共105例,其中干预组53例,对照组52例。干预前两组患者FBG、2 h-PBG、HbA1c水平比较,差异无统计学意义(P>0.05)。干预方法和时间对FBG、2 h-PBG、HbA1c水平有交互作用(P<0.05),干预方法和时间在FBG、2 h-PBG、HbA1c水平上主效应显著(P<0.05)。干预组患者干预第6个月和12个月的FBG、2 h-PBG、HbA1c水平均低于干预前,差异有统计学意义(P<0.05);对照组患者干预第6个月和12个月的FBG、2 h-PBG水平低于干预前,差异有统计学意义(P<0.05);干预组患者干预第12个月的FBG、2 h-PBG、HbA1c水平均低于干预第6个月,差异有统计学意义(P<0.05);对照组患者干预第12个月的2 h-PBG水平低于干预第6个月,差异有统计学意义(P<0.05);干预组患者干预第6个月和12个月FBG、2 h-PBG、HbA1c水平均低于对照组同期水平,差异有统计学意义(P<0.05)。干预前,两组患者SDSCA总得分及各维度得分比较,差异无统计学意义(P>0.05);干预后,干预组患者SDSCA总得分及各维度得分高于同组干预前和对照组,差异有统计学意义(P<0.05);干预后,对照组患者SDSCA总得分及各维度得分与干预前相比,差异无统计学意义(P>0.05)。 结论 实施OTO模式健康管理有助于老年2型糖尿病患者有效控制血糖水平,提高其自我管理行为能力,有利于实现对糖尿病的长期有效管理。

关键词: OTO模式, 糖尿病,2型, 血糖控制, 自我管理行为, 健康管理, 社区卫生服务

Abstract:

Background

The knowledge-based management model has been widely used in chronic disease management recently. The online-to-offline (OTO) model, a common internet-based chronic disease management model integrating online and offline resources, has been used in disease prevention besides disease treatment, and proven to be effective in supporting chronic disease management. However, there are few studies on the application of OTO model in the management of older adults with diabetes in China.

Objective

To explore the influence of OTO model on glycemic control and self-management behaviors in older adults with type 2 diabetes in the community.

Methods

By use of convenient sampling, older adults with type 2 diabetes (n=110) who were transferred from a tertiary hospital to five community hospitals in Shenyang were selected from August to October 2020. They were randomly assigned in a 1∶1 ratio, to receive a 12-month usual community-based health management (control group) , or a 12-month OTO model-based health management (intervention group) . The intervention results were evaluated by fasting blood glucose (FBG) , 2-hour postprandial glucose (2 h-PBG) and glycosylated hemoglobin (HbA1c) at baseline, and 6 months and 12 months after intervention, and total score and dimension scores of the Chinese version of Summary of Diabetes Self-care Activities (SDSCA-C) at baseline and 12 months after intervention.

Results

A total of 105 cases (53 in the intervention group and 52 in the control group) who completed the study were finally included. Two groups had was no significant differences in mean levels of baseline FBG, 2 h-PBG and HbA1c (P>0.05) . Significant interaction effects produced by the intervention method and time, and significant main effects brought by both intervention method and time on FBG, 2 h-PBG and HbA1c were observed (P<0.05) . FBG, 2 h-PBG and HbA1c levels in the intervention group decreased significantly either at 6 or 12 months after intervention (P<0.05) . But in the control group, only FBG and 2 h-PBG levels decreased significantly at 6 and 12 months after intervention (P<0.05) . The 12-month intervention lowered FBG, 2 h-PBG and HbA1c levels more significantly than 6-month intervention in the intervention group (P<0.05) . But in the control group, only 2 h-PBG level was lowered more significantly by 12-month intervention than 6-month intervention (P<0.05) . The intervention group had lower mean FBG, 2 h-PBG and HbA1c levels than the control group either at 6 or 12 months after intervention (P<0.05) . At baseline there were no differences between the two groups in total score and dimension scores of SDSCA-C (P>0.05) . After 12 months of intervention, the total score and dimension scores of SDSCA-C increased insignificantly in the control group (P>0.05) , but increased notably in the intervention group (P<0.05) . The intervention group had much higher total score and dimension scores of SDSCA-C than the control group after the intervention (P<0.05) .

Conclusion

The OTO model-based health management could contribute to improving glycemic control and self-management behaviors in older type 2 diabetics, which may benefit effective long-term management of diabetes.

Key words: Online-to-offline model, Diabetes mellitus, type 2, Glycemic control, Self-management behavior, Health management, Community health services