Abstract: Background　The prevalence of diabetes in China is increasing year by year with the advance of society.Moreover，diabetes-related complications cause serious economic burden.Peer support can improve the patients' ability of prevention and management of diabetes and reduce the workload of medical workers.Diabetes requires long-term interventions.However，the long-term（36 months） impact of peer support interventions on diabetes has been rarely studied.Objective　To explore the changes in diabetes-related knowledge level and self-management in type 2 diabetic patients with long-term peer support.Methods　This study started in 2013 and ended in 2016，lasting for 36 months.Participants were patients with a definite diagnosis of type 2 diabetes recruited from 5 community health centers in the southern area of Dongcheng District（formerly Chongwen District），Beijing.By use of sequentially numbered，opaque，sealed envelopes according to the random allocation sequence generated by the SAS，80 and 74 cases were assigned to the intervention group（intervened with peer support and standardized diabetic management） and control group（intervened with standardized diabetic management），respectively.Diabetic patients' data were collected before the intervention，and at the end of 6-month intervention in 2013 via the questionnaire survey，and at the end of 36-month intervention in 2016 via a follow-up.Changes in diabetes-related knowledge level，self-management behaviors，glycated hemoglobin and fasting blood glucose of two groups were evaluated.Results　76 in the intervention group and 68 in the control group who completed the follow-up were included in the final analysis.After 6 months of intervention，the awareness rates of the intervention group on the reference range of fasting blood glucose，diabetes hazard，diabetes prevention and control measures，unit value of food exchange，carbohydrate proportion，sequence of daily food intake，overweight standard of body mass index and recommended daily intake of edible oil for adults were higher than those of the control group（P<0.05）.At 36 months of intervention，the awareness rates of the intervention group on the reference range of fasting blood glucose，the hazard of diabetes，the proportion of carbohydrate，the daily recommended salt intake of adults and the daily recommended edible oil intake of adults were higher than those of the control group，with statistical significance（P<0.05）.Furthermore，higher percentages of patients improving their conditions by diet and exercise were also found in the intervention group（P<0.05）.At the end of 6-month intervention，mean levels of glycosylated hemoglobin and fasting blood glucose decreased more significantly in the intervention group，but at the end of 36-month intervention，mean levels of these two glycemic parameters became similar in both groups（P>0.05）.Conclusion　The results of this study show that community-based peer support interventions plus standardized diabetic management is effective in improving the self-management ability of type 2 diabetic patients，and the intervention effect may last for a long time，but the shorter-term effect is better，suggesting that to maintain the effect as long as possible，patients should maintain and consolidate glycemic control behaviors continually after a 6-month intervention with the assistance of further improved procedure.

Key words: Diabetes, type 2；Self-management；Peer support；Knowledge awareness；Glycosylated hemoglobin

摘要： 背景　随着社会发展，我国糖尿病患病率逐年递增，其并发症造成严重的经济负担。同伴支持可以提高患者对糖尿病的预防和管理能力，减轻医护人员的工作负担。糖尿病治疗是一个长期过程，目前缺少时间跨度达到3年的同伴支持干预的远期影响研究。目的　探讨同伴支持干预对2型糖尿病患者知识知晓及自我管理的远期影响。方法　本研究始于2013年，止于2016年，为期3年。以北京市东城区南片（原崇文区）5 个社区卫生服务中心为研究现场，招募确诊的2型糖尿病患者为研究对象，按照SAS软件下产生的随机分组序列，采用密闭、不透光信封将研究对象随机分为干预组和对照组。最终纳入干预组80人，对照组74人。干预组采用糖尿病规范化管理+同伴支持模式，对照组采用糖尿病规范化管理。2013年在干预前、干预6个月后分别对两组患者进行问卷调查，并在2016年进行3年期随访，对3个时间点的数据进行分析。评价两组患者健康知识知晓率、自我管理行为、糖化血红蛋白、空腹血糖。结果　最终完成随访的患者，干预组76人，对照组68人。干预6个月时，干预组对空腹血糖参考范围、糖尿病危害、糖尿病防治措施、食物交换份单位数值、碳水化合物占比、每日食物摄入量排序、体质指数超重标准、成人每日推荐食用油摄入量8项知晓率高于对照组，差异有统计学意义（P<0.05）。干预36个月时，干预组对空腹血糖参考范围、糖尿病危害、碳水化合物占比、成人每日推荐食盐摄入量、成人每日推荐食用油摄入量5项知晓率高于对照组，差异有统计学意义（P<0.05）。干预6、36个月时，干预组中进行饮食与运动控制的患者比例高于对照组（P<0.05）。干预6个月时，干预组糖化血红蛋白、空腹血糖水平低于对照组（P<0.05）；干预36个月时，两组糖化血红蛋白、空腹血糖比较，差异无统计学意义（P>0.05）。结论　同伴支持模式可以提升2型糖尿病患者自我管理能力，且存在远期效应，但短期效果优于远期效果，提示社区开展同伴支持模式虽然有效，但需要进一步完善干预程序，建议在6个月干预之后，继续干预以巩固其行为。

关键词: 糖尿病, 2型；自我管理；同伴支持；知识知晓；糖化血红蛋白