■自我血糖监测(SMBG)在2型糖尿病(T2DM)和糖尿病前期患者的血糖维持中起着至关重要的作用。该研究旨在描述基层社区中SMBG合并T2DM和糖尿病前期患者的现状。探讨SMBG频率与血糖水平之间的关系,并应用信息-动机-行为(IMB)模型分析基于电子问卷的SMBG依从性的潜在影响因素。
■对1388名T2DM和糖尿病前期患者进行了横断面研究,这些患者完成了由人口统计学和IMB模型内容组成的电子问卷。卡方检验,采用Mann-WhitneyU检验和多变量logistic回归模型分析探讨SMBG依从性的原因。
■这项研究的结果表明,在1388名T2DM患者中,只有26.2%(363/1388)的患者达到SMBG标准,表明与SMBG的低依从性。鉴于SMBG是糖尿病前期患者2型风险的个体预测因子之一,这一结果提示SMBG达标率有待提高。固定职业患者(OR=1.989,P=0.035),BMI在正常范围内(OR=1.336,P=0.049),吸烟习惯(OR=1.492,P=0.019),了解SMBG频率(OR=1.825,P<0.001),了解血糖控制目标(OR=1.414,P<0.001),了解血糖仪的所有功能(OR=1.923,P<0.001),方便购买血糖仪/试纸(OR=2.329,P=0.047),在遗忘血糖测试时进行补充测量(OR=2.044,P=0.005),测量血糖时旋转所有手指(OR=1.616,P<0.001)和针刺部位疼痛减轻(OR=2.114,P<0.001)是促进SMBG粘附的独立因素。然而,血糖仪缺乏可及性和便利性或沉重的经济负担是坚持SMBG的阻碍因素。此外,仍然存在缺乏保健知识和针刺疼痛等瓶颈。
■这项研究验证了将IMB模型应用于T2DM和糖尿病前期患者的SMBG的实用性。对SMBG的坚持仍有待改善,更加重视个人信息的改善,患者的动机和行为技能可能有利于在糖尿病自我管理的长期常规中保持对SMBG的更好依从性。
Self-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and pre-diabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires.
A cross-sectional study was conducted with 1388 T2DM and pre-diabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance.
The results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P<0.001), understanding control goal of blood glucose (OR=1.414, P<0.001), knowing all the functions of the blood glucose meter (OR=1.923, P<0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P<0.001) and less pain at the needling site(OR=2.114, P<0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain.
This study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management.