Page 78 - 2022-01-中国全科医学

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factors（such as diabetes prevalence and monitoring and other factors） of behaviors of monitoring（self-observation and screening
tests） to prevent chronic diabetic complications among type 2 diabetes patients receiving community-based management. Methods
The convenience sampling was used to select 785 type 2 diabetes patients from Chengdu's central urban areas who received
community-based type 2 diabetic management from May to November 2019. They were invited to attend a survey for understanding
their socio-demographic information and monitoring behaviors to prevent chronic diabetic complications using a questionnaire
developed by us. Results Only 103（13.1%） of the patients did not suffer from any chronic complications，and 435（55.4%）
suffered from both metabolic syndrome and chronic diabetic complications. The average total score for self-observation of chronic
diabetic complications in the participants was （2.58±0.86），but the average total score of regularly self-observation of pulsations
of the dorsalis pedis artery was only（1.47±0.84）. The average total score of performing screening tests for chronic diabetic
complications was（2.77±0.57）. The average score of diabetic retinopathy screening，peripheral neuropathy screening，and lower
extremity vascular disease screening was（1.88±0.99），（1.46±0.84），and （1.47±0.84），respectively. About 78.2%（614/785）
of patients underwent screening tests following the doctors' advices. But only 9.9%（78/785）took the initiative to conduct regular
tests. About 17.7%（139/785） and 49.0%（385/785） of the patients could not correctly manage the abnormal results of self-
observation and the screening test results. Multiple linear regression analysis indicated that the duration of diabetes since diagnosis，
prevalence of chronic diabetic complications，and management of self-observed abnormalities were associated with the score of self-
observation of chronic diabetic complications（P<0.05）. The duration of diabetes since diagnosis，the most recently measured
HbA 1c value，prevalence of chronic diabetic complications，causes and results management of screening tests for chronic diabetic
complications were associated with average total score of performing screening tests for chronic diabetic complications（P<0.05）.
Conclusion The prevalence of behaviors of monitoring to prevent chronic diabetic complications in community-dwelling type 2
diabetes patients was unsatisfactory，which was affected by the duration of diabetes since diagnosis，prevalence of chronic diabetic
complications，the most recently measured HbA 1c value，causes and results management of screening tests for chronic diabetic
complications. In view of this，in the delivery of community-based management services，attentions should be paid to improving
patients' initiative to actively and regularly observe their conditions and undergo relevant screening tests，thereby improving early
diagnosis and treatment rates of chronic type 2 diabetic complications.
【Key words】 Diabetes mellitus，type 2；Diabetes complications；Blood glucose self-monitoring；Screening tests；
Root cause analysis

2 型糖尿病已成为威胁大众健康的常见公共卫生问 的筛查率分别为 49.5%、75.3% 和 41.5%；LIU 等 ［11］ 研
题，长期高血糖可损伤血管和神经，使患者罹患多种慢 究发现，糖尿病患者周围神经病变筛查率为 32%。少有
性并发症，极大地加重了患者的经济负担 ［1-2］ ，甚至带 针对各类慢性并发症（包括相关合并症）监测行为状况
来极高的致残率和致死率 ［3］ 。然而，糖尿病慢性并发 的研究报道。基于此，本文调查社区管理的 2 型糖尿病
症由于具有早期症状、体征不典型，且随血糖控制和病 患者执行各类慢性并发症监测（自我观测和专项检测）
程发展而进行性加重等特点，较难被早发现、确诊和治 的行为状况，并探讨糖尿病患者患病情况、专项筛查的
疗。而要实现糖尿病治疗的终极目标，即有效控制并发 原因及对监测结果处理与其慢性并发症监测行为水平的
症，务必要早期发现和确诊，尤其是慢性并发症。早期 关系，为进一步提升患者慢性并发症的监测行为水平提
发现和诊断的基础是进行定期监测，包括针对各项慢性 供实证依据。
并发症尽早、持续地进行专项筛查和患者主动的自我观 1 对象与方法
测 ［4-6］ 。我国 2 型糖尿病防治指南也明确指出了进行慢 1.1 研究对象 2019年5—11月，采用方便抽样的方式，
性并发症（包括相关合并症）规律筛查的必要性，并给 在成都市中心城区选取愿意配合的社区卫生服务机构及
出了各类慢性并发症的筛查频次 ［7］ 。为此，促进患者 其全科团队，然后在全科团队对 2 型糖尿病患者提供管
按指南要求持续、规律地进行慢性并发症的筛查和自我 理服务时，按纳排标准纳入调查对象，征得患者同意后
观测也应成为社区 2 型糖尿病管理不可忽视的工作内容 实施调查。样本量确定采用横断面调查样本量估算公式
2
之一。回顾文献发现，现有研究大多集中在某项或几项 N=U 1-α/2 P 0 （1-P 0 ）/d 2［12］ ，其中统计检验水准 α 取值
慢性并发症的筛查，如英国 ［8］ 、澳大利亚 ［9］ 的研究显 0.05，查表得 U 1-α/2 =1.96，P 0 表示可能的概率（查文献
示，被调查糖尿病患者前一年参加过糖尿病眼病筛查者 选用相对低的周围神经病变筛查率，即 32% ［11］ ），d
占比为 77.7%~82.2%；我国赵文惠等 ［10］ 对微血管并发 为允许误差（本研究采用 0.2P，即 0.064）。计算出最
症的筛查情况的调查结果显示，眼病、肾病和糖尿病足 少样本量为 204，考虑到不应答情况，在此基础上增加