2型糖尿病患者饮食决策辅助工具编制及应用研究

doi:10.3761/j.issn.1672-9234.2024.06.008

摘要/Abstract

摘要：

目的编制2型糖尿病（type 2 diabetes mellitus，T2DM）患者饮食决策辅助工具，并评价其临床应用效果。方法基于T2DM饮食决策辅助工具最佳证据、渥太华决策支持框架、国内外T2DM患者饮食决策相关研究，形成T2DM患者饮食决策辅助工具初稿，并根据国际患者决策辅助工具要求通过专家会议、用户评估对工具初稿进行修订和完善。选取2022年4月—9月在湖南省某三级甲等医院内分泌科住院的62例T2DM患者为研究对象，按照入院顺序将其分入对照组（4月—6月入院，n=31）和试验组（7月—9月入院，n=31），对照组接受常规护理，试验组接受常规护理联合T2DM患者饮食决策辅助工具干预。分别于干预前、出院3个月后比较两组糖尿病饮食治疗依从性、决策冲突，以及客观指标[BMI、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）]水平。结果编制的T2DM患者饮食决策辅助工具由决策阶段评估、信息支持、利弊分析、支持系统、价值思考、决策制订倾向性和决策确认7个部分组成。最终对照组29例、试验组30例完成本研究。出院3个月后，试验组糖尿病饮食治疗依从性得分高于对照组（P<0.05）；决策冲突总得分、FPG、HbA1c、LDL-C低于对照组（P<0.05）。结论 T2DM患者饮食决策辅助工具的运用在一定程度上可以提高T2DM患者饮食治疗依从性，降低其决策冲突水平，改善其血糖与血脂水平。

关键词: 糖尿病, 2型, 饮食决策, 决策辅助工具, 决策冲突, 共同决策

Abstract:

Objective To develop a dietary decision aids tool for patients with type 2 diabetes mellitus （T2DM） and evaluate its clinical application effect. Methods Firstly，a draft of the dietary decision aids for T2DM patients was formed based on the best evidence of dietary decision-making support tools for T2DM，the Ottawa Decision Support Framework，and relevant research on dietary decision-making for T2DM patients home and abroad. Then，the draft was revised and improved through expert meetings and user evaluations in accordance with international patient decision aid standards. A total of 62 T2DM patients admitted to the endocrinology department of a Grade-A tertiary hospital in Hunan Province from April to September 2022 were selected as the participants. They were divided into a control group（admitted from April to June，n=31） and an experimental group （admitted from July to September，n=31） depending on their order of admission. The control group received routine care，while the experimental group received routine care combined with the dietary decision aids intervention. Indicators were compared between the two groups before the intervention and three months after discharge，including the compliance with diabetes diet therapy，decision-making conflict，and BMI，fasting plasma glucose（FPG），glycated hemoglobin （HbA1c），total cholesterol（TC），triglycerides（TG），low-density lipoprotein（LDL-C），and high-density lipoprotein（HDL-C）. Results The constructed dietary decision aids for T2DM patients mainly consisted of seven components：decision-making stage assessment，information support，pros and cons analysis，support system，value consideration，decision-making tendency，and decision confirmation. 29 patients in the control group and 30 patients in the experimental group completed this study. The scores of diabetes diet control knowledge and compliance with diet therapy in the experimental group were higher than those in the control group（P<0.05） at three-month after discharge. The scores of decision-making conflict，FPG，HbA1c，and LDL-C were lower in the experimental group than in the control group（P<0.05）. Conclusion The application of the dietary decision aids for T2DM patients can，to a certain extent，improve the compliance with diet therapy among T2DM patients，while reducing their decision-making conflict，blood glucose，and blood lipids.

Key words: Diabetes mellitus, Type 2, Dietary decisions, Decision aids, Decision conflict, Shared decision-making

刘东玲, 秦月兰, 李珍, 周娟, 袁平. 2型糖尿病患者饮食决策辅助工具编制及应用研究[J]. 中华护理教育, 2024, 21(6): 686-694.

LIU Dongling, QIN Yuelan, LI Zhen, ZHOU Juan, YUAN Ping. Development and application of a dietary decision aids for type 2 diabetes patients[J]. Chinese Journal of Nursing Education, 2024, 21(6): 686-694.

图/表 4

参考文献 30

[1]	International Diabetes Federation. IDF Diabetes Atlas 2021[EB/OL]. (2021-12-06)[2023-06-05]. https://diabetesatlas.org/atlas/tenth-edition/.
[2]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 国际内分泌代谢杂志, 2021, 41(5):482-548.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)[J]. Int J Endocrinol Metab, 2021, 41(5):482-548.
[3]	尤黎明, 吴瑛. 内科护理学[M]. 7版. 北京: 人民卫生出版社, 2022:508-528.
[4]	Raj GD, Hashemi Z, Soria Contreras DC, et al. Adherence to diabetes dietary guidelines assessed using a validated questionnaire predicts glucose control in adults with type 2 diabetes[J]. Can J Diabetes, 2018, 42(1):78-87. doi: S1499-2671(16)30608-6 pmid: 28648765
[5]	刘佳丽, 张众, 迟爽, 等. 认知饮食方案在2型糖尿病肾病透析患者中的护理效果[J]. 西部医学, 2018, 30(10):1542-1546.
	Liu JL, Zhang Z, Chi S, et al. The effect of cognitive diet nursing program in patients with type 2 diabetic nephropathy[J]. Med J West China, 2018, 30(10):1542-1546.
[6]	赵静, 赵秋利, 侯赛宁, 等. 2型糖尿病患者饮食行为影响因素的质性研究[J]. 护理学杂志, 2018, 33(5):35-38.
	Zhao J, Zhao QL, Hou SN, et al. A qualitative study on factors influencing eating behaviors of persons with type 2 diabetes[J]. J Nurs Sci, 2018, 33(5):35-38.
[7]	李光琴, 何彩云, 尹红芳, 等. 2型糖尿病中青年患者饮食管理体验的研究[J]. 中华护理教育, 2020, 17(5):401-405.
	Li GQ, He CY, Yin HF, et al. Diet management experiences of young and middle-aged patients with type 2 diabetes:a qualitative study[J]. Chin J Nurs Educ, 2020, 17(5):401-405.
[8]	Jalilian H, Pezeshki MZ, Janati A, et al. Readiness for weight change and its association with diet knowledge and skills,diet decision making and diet and exercise barriers in patients with type 2 diabetes[J]. Diabetes Metab Syndr, 2019, 13(5):2889-2895. doi: S1871-4021(19)30469-2 pmid: 31425953
[9]	Stacey D, Lewis KB, Smith M, et al. Decision aids for people facing health treatment or screening decisions[J]. Cochrane Database Syst Rev, 2024, 1(1):CD001431.
[10]	Durand MA, Dannenberg MD, Saunders CH, et al. Modified Delphi survey for the evidence summarisation of patient decision aids:study protocol[J]. BMJ Open, 2019, 9(3):e026701.
[11]	胡子奇, 刘俊荣. 医患共享决策的价值意蕴、影响因素及辅助工具[J]. 医学与哲学, 2020, 41(4):1-6.
	Hu ZQ, Liu JR. Value,influencing factors and patient decision aid of sharing decision-making[J]. Med Philos, 2020, 41(4):1-6.
[12]	Kim EK, Kwak SH, Jung HS, et al. The effect of a smartphone-based,patient-centered diabetes care system in patients with type 2 diabetes:a randomized,controlled trial for 24 weeks[J]. Diabetes Care, 2019, 42(1):3-9.
[13]	Swoboda CM, Miller CK, Wills CE. Impact of a goal setting and decision support telephone coaching intervention on diet,psychosocial,and decision outcomes among people with type 2 diabetes[J]. Patient Educ Couns, 2017, 100(7):1367-1373.
[14]	Kumar D, Joshi A, Grover A, et al. Effect of personalized human-centered dietary decision support system(PHCDDSS) on dietary knowledge,attitude,practice(KAP),and mean fasting blood sugar(FBS) among participants with type 2 diabetes mellitus(T2DM) in community-based settings of northern state of India[J]. J Diabetol, 2021, 12(3):338.
[15]	葛声, 张片红, 马爱勤, 等. 《中国2型糖尿病膳食指南》及解读[J]. 营养学报, 2017, 39(6):521-529.
[16]	Diabetes Canada Clinical Practice Guidelines Expert Committee. Nutrition therapy[J]. Can J Diabetes, 2018, 42(Suppl 1):S64-S79.
[17]	中国医疗保健国际交流促进会营养与代谢管理分会, 中国营养学会临床营养分会, 中华医学会糖尿病学分会, 等. 中国糖尿病医学营养治疗指南(2022版)[J]. 中华糖尿病杂志, 2022, 14(9):881-933.
	Nutrition and Metabolic Management Branch of China International Exchange and Promotive Association for Medical and Health Care,Clinical Nutrition Branch of Chinese Nutrition Society, Chinese Diabetes Society, et al. Chinese guidelines of medical nutrition therapy in diabetes(2022 edition)[J]. Chin J Diabetes Mellitus, 2022, 14(9):881-933.
[18]	中华人民共和国国家卫生健康委员会. 成人糖尿病食养指南(2023年版)[EB/OL]. (2023-01-18)[2023-04-02]. http://www.nhc.gov.cn/sps/s7887k/202301/0e55a01df50c47d9a4a43db026e3afc3.shtml.
[19]	Wei I, Pappas Y, Car J, et al. Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus[J]. Cochrane Database Syst Rev, 2011, 2011(12):CD008488.
[20]	McLaughlin AC, Whitlock LA, Lester KL, et al. Older adults’ self-reported barriers to adherence to dietary guidelines and strategies to overcome them[J]. J Health Psychol, 2017, 22(3):356-363. doi: 10.1177/1359105315603472 pmid: 26385067
[21]	Kumar D, Bhardwaj A, Sharma S, et al. Designing and evaluating a personalized,human-centered dietary decision support system for use among people with diabetes in an Indian setting:protocol for a quasi-experimental study[J]. JMIR Res Protoc, 2022, 11(3):e13635.
[22]	American Diabetes Association. 2. Classification and diagnosis of diabetes:standards of medical care in diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1):S13-S28.
[23]	孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014:574.
[24]	史润泽. 植入型心律转复除颤器患者决策辅助工具编制及应用研究[D]. 北京: 北京协和医学院, 2019.
	Shi RZ. Development and application of a decision aid for implantable cardioverter defibrillator candidates[D]. Beijing: Peking Union Medical College, 2019.
[25]	张萍. 糖尿病患者饮食治疗依从性及健康教育效果研究[D]. 长春: 吉林大学, 2008.
	Zhang P. Study on the diet therapy compliance and the effect of health education among patients with diabetes mellitus[D]. Changchun: Jilin University, 2008.
[26]	Lam WW, Kwok M, Liao QY, et al. Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery[J]. Health Expect, 2015, 18(2):210-220. doi: 10.1111/hex.12021 pmid: 23167846
[27]	Stacey D, Légaré F, Boland L, et al. 20th anniversary Ottawa decision support framework:part 3 overview of systematic reviews and updated framework[J]. Med Decis Making, 2020, 40(3):379-398. doi: 10.1177/0272989X20911870 pmid: 32428429
[28]	李学靖, 杨丹, 张小艳, 等. 患者决策辅助工具的构建方法与内容呈现标准的研究进展[J]. 中华现代护理杂志, 2022, 28(16):2101-2105.
	Li XJ, Yang D, Zhang XY, et al. Research progress on construction methods and content presentation standards of patient decision aids[J]. Chin J Mod Nurs, 2022, 28(16):2101-2105.
[29]	Linda MD. Nutritional considerations in type 2 diabetes mellitus[EB/OL]. (2024-02-05). https://www.uptodate.com/contents/medical-nutrition-therapy-for-type-2-diabetes-mellitus.
[30]	Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission:systematic review and meta-analysis of published and unpublished randomized trial data[J]. BMJ, 2021, 372:m4743.