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目的:探讨中国社区糖尿病患者从家人或朋友获得直接支持和间接支持的现状,以及患者获得的直接支持与间接支持水平与其自我管理行为的相关关系。方法:研究对象的数据来自“北京市通州区社区诊断(2015)”专项调查,对符合要求的474名社区糖尿病患者进行问卷调查、体格检查和糖化血红蛋白(glycated hemoglobin,Hb A1c)测量。应用糖尿病自我管理行为量表(the summary of diabetes self-care activities measure,SDSCA)对自我管理行为进行测量,应用糖尿病直接支持和间接支持量表(directive and nondirective support scale among patients with diabetes,DNSS-PD)对直接支持和间接支持水平进行测量,分析患者获得的直接支持与间接支持水平与其自我管理行为的相关关系。结果:共有452名患者纳入分析,患者获得的直接支持实际情况平均得分为2.53±1.07,27.6%患者获得的直接支持水平较高。患者获得的间接支持实际情况平均得分为3.13±1.12,50.8%患者获得的间接支持水平较高。患者SDSCA平均总得分为35.38±14.21,得分率为45.95%,仅20.6%患者自我管理的总体情况较好。直接支持水平高组患者的SDSCA平均总得分、饮食和运动维度得分、自我管理总体情况、饮食和运动维度自我管理情况显著优于直接支持水平低组。间接支持水平高组患者的SDSCA平均总得分,饮食、运动、血糖监测、足部护理、吸烟维度得分,自我管理总体情况,饮食、运动、血糖监测、足部护理以及吸烟维度自我管理情况均显著优于间接支持水平低组。性别(OR=2.729)、间接支持水平(OR=4.890)、年龄(OR=0.969)和体质指数(body msss index,BMI)(OR=0.819)是自我管理行为的重要影响因素。结论:社区糖尿病患者的自我管理情况不太理想,患者获得的间接支持水平高于直接支持水平,但均有待提升。间接支持和间接支持水平高均与糖尿病患者较好的自我管理行为相关,间接支持水平高与5个维度较好的自我管理行为均相关,直接支持水平高与较好的饮食和运动维度的自我管理行为相关。应对于社区男性老年肥胖的糖尿病患者的自我管理给予更多的关注和支持,特别是间接支持。
OBJECTIVE: To investigate the current status of direct and indirect support from family members or friends of Chinese community diabetic patients and the correlation between the level of direct support and indirect support acquired by patients and their self-management behaviors. Methods: The data of the study were collected from a survey of community-based diagnoses (2015) in Tongzhou District of Beijing, and questionnaires, physical examination and glycated hemoglobin (Hb A1c) were measured in 474 community-based diabetics who met the requirements. Self-management behaviors were measured using the summary of diabetes self-care activities measure (SDSCA), and the guidelines and nondirective support scales among patients with diabetes (DNSS-PD ) Measures the level of direct support and indirect support, and analyzes the correlation between the level of direct support and indirect support that patients receive and their self-management behavior. Results: A total of 452 patients were included in the analysis. The average score of patients receiving direct support was 2.53 ± 1.07, and the rate of direct support was higher in 27.6% of patients. The actual average score of patients receiving indirect support was 3.13 ± 1.12 and the level of indirect support obtained by 50.8% of patients was higher. The average score of patients with SDSCA was 35.38 ± 14.21, with a score of 45.95%. Only 20.6% of patients had better overall self-management. The SDSCA average total score, diet and exercise dimension scores, overall self-management, self-management of diet and exercise dimensions were significantly better than those with low level of direct support directly supporting patients with high level group. The SDSCA total score, diet, exercise, glucose monitoring, foot care, smoking dimension score, overall self-management profile, diet, exercise, glucose monitoring, foot care, and self-management of smoking dimensions Better than the indirect support low level group. Gender (OR = 2.729), indirect support (OR = 4.890), age (OR = 0.969) and body mass index (BMI) were significant predictors of self-management behavior. Conclusion: Self-management of patients with diabetes in community is less than ideal, and the level of indirect support received by patients is higher than that of direct support, but they all need to be improved. Indirect support and high levels of indirect support are all associated with better self-management behaviors in people with diabetes, high levels of indirect support are associated with better self-management in all five dimensions, and direct support is given to self with high levels and better diet and exercise dimensions Management activities related. More attention and support should be given to the self-management of elderly, obese diabetic patients in community-based communities, especially with indirect support.