健康教育对糖尿病视网膜病变患者行为改变的效果

目的探讨健康教育对糖尿病视网膜病变患者行为改变的影响。方法由经过糖尿病专科护士培训的人员对134例糖尿病视网膜病变患者实施健康教育,比较健康教育前及健康教育1年后患者的行为改变及血糖控制情况。结果实施健康教育1年后,134例糖尿病视网膜病变患者在饮食治疗、运动治疗和自我监测等方面的行为改变差异有统计学意义(P<0.05);患者的空腹血糖、餐后2 h血糖及糖化血红蛋白值均低于健康教育前,差异有统计学意义(均P<0.01)。结论健康教育能有效控制糖尿病视网膜病变患者的空腹血糖、餐后2 h血糖及糖化血红蛋白水平,促进患者养成良好的行为习惯,有利于糖尿病视网膜病变的控制。     

2型糖尿病住院患者慢性并发症危险因素分析

目的:分析大连地区2型糖尿病住院患者糖尿病慢性并发症的相关危险因素。方法:①收集2005-01/2006-12大连医科大学附属第二医院内分泌科住院2型糖尿病患者579例。符合1999年世界卫生组织糖尿病诊断标准,且对检测项目知情同意。②收集个人资料,测量体脂测量参数(体质量指数、腰围、臀围、股围)以及实验室检查指标(血糖、血脂、24h尿白蛋白、胰岛素敏感相关指标)。根据国际临床分类法,24h尿白蛋白情况,神经肌电图,彩超检查、头部CT、心电图以及酶学诊断糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病大血管并发症。③使用Logistic逐步回归分析各危险因子对糖尿病并发症的贡献大小。结果:糖尿病患者579例均进入结果分析,其中42.3%合并糖尿病视网膜病变,其中4.5%为增殖型视网膜病变;63.2%合并糖尿病周围神经病变;37.0%合并糖尿病肾脏病变;56.6%合并糖尿病大血管并发症。多因素Logistic回归分析结果:①糖尿病病程、收缩压、糖化血红蛋白、腰股比为糖尿病肾脏病变独立危险因素(偏回归系数分别为0.005,0.019,0.069,6.693,P<0.05￣0.01)。②糖尿病病程、糖化血红蛋白、空腹血糖、血总胆固醇、24h尿白蛋白为糖尿病视网膜病变独立危险因素(偏回归系数分别为0.014,0.158,0.536,0.039,0.006,P<0.05￣0.01)。③糖尿病病程、年龄、血总胆固醇、空腹血糖为糖尿病周围神经病变独立危险因素(偏回归系数分别为0.016,0.039,0.608,0.433,P<0.05￣0.01)。④年龄、体质量指数、胰岛素抵抗指数、空腹血糖、总胆固醇、24h尿白蛋白为糖尿病大血管并发症独立危险因素(偏回归系数分别为0.085,0.092,0.248,1.153,0.937,0.002,P<0.05￣0.01)。高密度脂蛋白胆固醇为糖尿病大血管并发症独立保护因素(偏回归系数为0.992,P<0.05)。结论:腰股比是糖尿病肾脏病变的主要危险因素,糖化血红蛋白、空腹血糖是糖尿病视网膜病变的主要危险因素,空腹血糖、总胆固醇是糖尿病大血管并发症和糖尿病周围神经病变的主要危险因素。     

糖尿病视网膜病变相关因素分析与社区护理

目的:探讨糖尿病患者视网膜病变发生的相关因素社区护理方法.方法:将205例糖尿病住院患者根据糖尿病视网膜病变(DR)诊断标准将患者分为DR组(158例)与非DR组(47例),对其基本情况如年龄、病程、血压及空腹血糖等实验室检查指标进行统计,分析DR发生的相关因素,针对病变因素实施相应的社区护理干预.结果:DR组糖尿病病程更长,尿素、尿酸、血压、WBC、中性粒细胞更高,两组比较有统计学意义(P<0.05);DR组与非DR组比较年龄的构成和空腹血糖差异无统计学意义(P>0.05).结论:对DR患者在社区实施降糖治疗和健康教育等护理干预措施,能提高患者的自护能力,有效控制血糖、血压和预防DR的发生,提高糖尿病患者的生活质量.     

糖尿病患者社区综合护理效果观察

目的 制订糖尿病患者护理干预措施,探讨社区护理对糖尿病患者康复的影响.方法 选择社区内确诊的2型糖尿病患者61例,建立个人健康档案,给予健康教育,包括饮食、运动、心理、督导药物治疗及定期血糖监测等干预措施.比较干预措施实施前后患者遵医行为,空腹血糖及糖化血红蛋白控制情况.结果 社区护理行为干预后,糖尿病患者定期体检、饮食控制、定期血糖监测和运动疗法等遵医行为人数较干预前明显提高,差异有统计学意义(P<0.05);干预后空腹血糖和糖化血红蛋白控制良好,较干预前差异有统计学意义(P<0.01).结论 对糖尿病患者采用社区护理行为干预,效果良好.     

护理干预对老年2型糖尿病患者的影响

目的:探讨护理干预对老年2型糖尿病患者的影响。方法:将80例老年2型糖尿病患者随机分为干预组和对照组各40例,对照组给予健康教育门诊常规性糖尿病防治知识教育,干预组在此基础上实施护理干预。连续进行为期1年的追踪观察,比较两组干预前后的空腹血糖、三酰甘油、总胆固醇及体重指数。结果:两组干预后空腹血糖、三酰甘油、总胆固醇、体重指数优于干预前(P<0.05,P<0.01),干预组干预后空腹血糖、三酰甘油、总胆固醇、体重指数优于对照组(P<0.05,P<0.01)。结论:护理干预可提高老年2型糖尿病患者对疾病的认知能力,降低糖尿病危险因素,有效控制并发症的发生。     

社区护理对早期糖尿病视网膜病变患者预后的影响

目的:探讨社区护理对早期糖尿病视网膜病变患者预后的影响。方法:对2013年1月~2014年6月期间在我社区接受治疗的60例早期糖尿病视网膜病变患者进行临床研究,并实施社区护理干预,观察分析在实施干预前后患者的指标变化。结果:实施社区护理干预之后,患者的空腹血糖、餐后2 h的血糖、甘油三酯、糖化血红蛋白含量、体重指数均明显降低,差异有统计学意义(P均0.05)。患者视力程度较实施前提高,差异有统计学意义(P0.05)。结论:进行社区护理可提高早期糖尿病视网膜病变患者的预后情况,效果较好。     

老年2型糖尿病患者糖尿病视网膜病变危险因素分析

目的：探讨老年2型糖尿病患者糖尿病视网膜病变的危险因素。方法：将158例老年2型糖尿病患者分为合并视网膜病变组75例，无视网膜病变组83例，分析两组患者之间病程、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、收缩压、舒张压、血清脂蛋白α、载脂蛋白Al、载脂蛋白B等因素与视网膜病变的相关性。结果：两组间性别、年龄差异无统计学意义（P〉0．05），组间病程、空腹血糖、餐后2h血糖、糖化血红蛋白、血清脂蛋白α、载脂蛋白Al、载脂蛋白B、甘油三酯收缩压、舒张压相比差异有统计学意义（P〈0．05）。结论：病程、血糖、血脂以及血清脂蛋白α等均是发生视网膜病变的主要因素。     

健康教育对糖尿病视网膜病变患者饮食行为改变的研究

目的:探讨健康教育对糖尿病视网膜病变患者饮食行为改变的干预效应。方法:对134例糖尿病视网膜病变患者采用自身对照方法,比较在接受健康教育前后的饮食行为改变及各代谢指标的变化。结果:134例糖尿病视网膜病变患者教育前后饮食行为改变有显著性差异(P<0.05);教育前后患者血压、空腹血糖、早餐后2 h血糖、糖化血红蛋白、甘油三脂、高密度脂蛋白胆固醇、尿微量白蛋白有显著性差异(P<0.05)。结论:对糖尿病视网膜病变患者实施健康教育提高了患者饮食治疗的依从性,改善了患者的血压、糖代谢及脂代谢指标,同时提高了患者对护士的信任度,增进了护患关系,提高了护士的自我价值。     

空腹血糖受损合并高血压患者高血压视网膜病变伴随状况及特征分析

目的:探讨空腹血糖受损合并高血压患者高血压视网膜病变伴随状况及相关危险因素.方法:对85例>40岁空腹血糖受损合并高血压患者中高血压视网膜病变的发病率及其相关危险因素进行分析.结果:高血压视网膜病变患病率为82.35%,男性(76.19%)与女性(88.37%)患病率比较差异无统计学意义(P=0.141),随年龄增长和高血压痛程延长,高血压视网膜病变患病率明显增加.Logistic回归分析结果显示,高血压视网膜病变的危险因素为年龄、高血压病程和高总胆固醇.结论:空腹血糖受损合并高血压患者可控危险因素主要是血脂代谢紊乱.     

糖尿病视网膜病变的危险因素分析与护理干预对策

目的探讨糖尿病视网膜病变的危险因素与相应的护理干预对策。方法选取2018年1—7月于我院治疗的糖尿病患者200例,研究影响糖尿病视网膜病变(DR)的危险因素。结果单因素回归分析结果显示,病程、胰岛素治疗史、空腹血糖、最佳矫正视力、高血压病及高血脂均是影响DR的相关因素(P 0. 05),多因素回归分析显示,胰岛素治疗史是保护因素,高血压、空腹血糖及病程均为导致DR的独立危险因素(P 0. 05),并提出护理对策。结论高血压及病程均为导致DR的独立危险因素,其中空腹血糖是作为一个暂时性的指标。     

Risk factors for diabetic retinopathy: a population-based study in Rochester, Minnesota

Retinopathy is an important sequela of diabetes mellitus, but clinical risk factors for this condition have rarely been assessed in a geographically defined population. In this population-based study, the 1135 Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort) were followed through their complete medical records in the community to January 1, 1982. Because most of the cases of diabetic retinopathy in Rochester residents developed in patients with non-insulin-dependent diabetes mellitus (NIDDM), risk factors for diabetic retinopathy were examined in this group (N = 1031). A proportional hazards model identified the following risk factors for diabetic retinopathy in NIDDM: elevated initial fasting blood glucose level, marked obesity, and earlier age at onset of diabetes. Stratified analyses indicated that duration of diabetes was also significantly associated with an increased risk of retinopathy. Two secular trends, increasing detection of "mild" NIDDM and decreasing risk of diabetic retinopathy, had a major effect on retinopathy risk assessment. These data also suggest that insulin therapy is not an independent risk factor for diabetic retinopathy.     

2型糖尿病患者糖尿病视网膜病变检出率及其相关危险因素分析

目的：探讨2型糖尿病患者糖尿病视网膜病变（DR）的发生率及相关危险因素。方法：收集448例2型糖尿病患者的眼底检查情况及其他临床资料,根据眼底检查结果将患者分为糖尿病无视网膜病变（NDR）及糖尿病视网膜病变（DR）组,比较可能诱发DR的危险因素。结果：112例患者合并DR占总数的25．0％。年龄、糖尿病病程、收缩压、尿素氮、肌酐、尿微量白蛋白以及高血压、脑梗死合并率两组之间的差异有统计学意义。Logistic回归糖尿病病程、尿微量白蛋白是DR发生的独立危险因素。结论：我院住院2型糖尿病患者中25．0％合并DR,糖尿病病程、尿微量白蛋白是DR独立的危险因素。     

Diabetic microvascular complications: can patients at risk be identified? A review

People with diabetes have an increased risk of developing microvascular complications, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy, which, if undetected or left untreated, can have a devastating impact on quality of life and place a significant burden on health care costs. In addition, diabetic microvascular complications can reduce life expectancy. The strongest risk factors are glycaemic control and diabetes duration; however, other modifiable risk factors such as hypertension, hyperlipidaemia and smoking, and unmodifiable risk factors including age at onset of diabetes and genetic factors may all play a part. Along with the presence of external risk factors, some associations have also been noted between diabetic microvascular complications themselves. There is evidence that diabetic retinopathy in association with increased blood pressure is an important risk factor for diabetic nephropathy progression. Significant correlations have also been shown between the presence of diabetic peripheral neuropathy and the presence of background or proliferative diabetic retinopathy. Clinical trials are currently in progress looking at a number of approaches to designing treatments to prevent the adverse effects of hyperglycaemia. It is essential however, that risk factors associated with the progression and development of diabetic microvascular complications are detected and treated at an early stage in order to further reduce morbidity and mortality. Considering all three complications as interrelated may well facilitate early detection of microvascular disease. Despite good long-term glycaemic and blood pressure control, diabetes remains a major cause of blindness, renal failure and amputations. As the incidence of diabetes continues to rise, the burden of diabetic microvascular complications will increase in future, hence the need for early detection. Considering the microvascular complications of diabetes as related, and enquiring proactively about complications, may well facilitate early detection of microvascular disease.     

Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review

OBJECTIVE: To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients in mortality and end-stage complications and 2) are there ethnic differences among diabetic patients in quality of care? RESEARCH DESIGN AND METHODS: A review of the literature on ethnic differences in the prevalence of complications and mortality among diabetic patients and in the quality of diabetes care was performed by systematically searching articles on Medline published from 1987 through October 2004. RESULTS: A total of 51 studies were included, mainly conducted in the U.S. and the U.K. In general, after adjusting for confounders, diabetic patients from ethnic minorities had higher mortality rates and higher risk of diabetes complications. After additional adjustment for risk factors such as smoking, socioeconomic status, income, years of education, and BMI, in most instances ethnic differences disappear. Nevertheless, blacks and Hispanics in the U.S. and Asians in the U.K. have an increased risk of end-stage renal disease, and blacks and Hispanics in the U.S. have an increased risk of retinopathy. Intermediate outcomes of care were worse in blacks, and they were inclined to be worse in Hispanics. Likewise, ethnic differences in quality of care in the U.S. exist: process of care was worse in blacks. CONCLUSIONS: Given the fact that there are ethnic differences in diabetes care and that ethnic differences in some diabetes complications persist after adjustment for risk factors other than diabetes care, it seems the case that ethnic differences in diabetes care contribute to the more adverse disease outcomes of diabetic patients from some ethnic minority groups. Although no generalizations can be made for all ethnic groups in all regions for all kinds of complications, the results do implicate the importance of quality of care in striving for equal health outcomes among ethnic minorities.     

糖尿病视网膜病变患者认知状况及护理干预调查

目的 探讨门规糖尿病患者对眼部视网膜病变的认知程度以及护理干预效果.方法 对231例门规糖尿病视网膜病变患者进行问卷调查、护理健康教育、眼部检查等,并对调查资料进行分析.结果 调查表明,糖尿病引起眼病知晓率55.85%,其致盲知晓率30.30%;糖尿病视网膜病变为眼部主要病变知晓率37.66%,其致盲知晓率26.40%,护理干预后其知晓率为100%.结论 糖尿病患者对糖尿病眼病有一定认识,对糖尿病视网膜病变认识不足,护理干预作为医疗辅助措施对指导患者治疗、改善转归意义重大.     

山西省城乡糖尿病视网膜病变患病率及相关因素分析

目的：调查山西省城乡2型糖尿病并发糖尿病视网膜病变（diabetic retinopathy,DR）的患病率,探讨DR发生的相关危险因素。方法：对研究对象现场问卷调查及眼底检查,对所调查的数据进行统计学分析。结果：太原市省直机关DR的患病率为7.51%,平遥县农村的DR患病率为18.28%。高经济收入优势比（OR）及95%可信限（95%CI）值：太原为0.209（0.050~0.881）,平遥县农村为0.034（0.002~0.563）;文化程度OR与95%CI值：太原为0.040（0.004~0.387）,平遥县农村为0.033（0.001~0.745）;糖尿病病程OR与95%CI值：太原为1.444（1.011~2.063）,平遥县农村为2.165（1.178~3.982）均于DR有相关性。结论：山西省太原市DR患病率低于平遥县农村;经济收入,文化程度及糖尿病病程是DR发生的危险因素。     

Normotensive women with type 2 diabetes and microalbuminuria are at high risk for macrovascular disease

OBJECTIVE: The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men. The pathogenesis for this risk difference has not been fully elucidated. We investigated whether female sex was associated with macrovascular disease and death, independently of known risk factors related to type 2 diabetes, nephropathy, or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS: We conducted a prospective, prolonged follow-up study of a subgroup of 67 diabetic patients (46 men and 21 women) without established cardiovascular disease who participated in a larger clinical trial. Data were collected on current and past health, medication use, blood pressure, renal function, and HbA(1c) during the follow-up period of 4.7 +/- 0.8 (means +/- SE) years. The end point was a composite of death, cardiovascular disease, cerebrovascular events, and peripheral artery disease. RESULTS: Of the women, eight (38.1%) met the end point compared with six (13.4%) of the men (P = 0.02 for difference in event-free survival). The hazard ratio of women relative to men was 3.19 (95% CI 1.11-9.21), which further increased after adjusting for age, systolic blood pressure, BMI, smoking, total-to-HDL cholesterol ratio, urinary albumin excretion, and retinopathy. CONCLUSIONS: In our study population of normotensive patients with type 2 diabetes and microalbuminuria, female sex was associated with increased risk of fatal and nonfatal cardiovascular disease, independent of the classical cardiovascular risk factors, the severity of nephropathy or presence of retinopathy, or health care utilization.     

Epidemiology of proliferative diabetic retinopathy.

OBJECTIVE--This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative diabetic retinopathy. In addition, the relation of proliferative retinopathy to other systemic complications associated with diabetes is reviewed. RESEARCH DESIGN AND METHODS--The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at < 30 yr of age and 1370 older-onset people whose diabetes was diagnosed at > or = 30 yr of age, and who were taking or not taking insulin. RESULTS--The major finding is that proliferative retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative retinopathy in the younger-onset group. The presence of proliferative diabetic retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, diabetic nephropathy, and mortality. In the WESDR, a significant number of diabetic people with proliferative retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation. CONCLUSIONS--These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative retinopathy. They also suggest that once proliferative diabetic retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative retinopathy.     

糖尿病临床健康教育管理效果的影响因素分析

目的：探讨影响糖尿病健康教育管理临床效果的可能因素。方法2014年4月至2015年3月,我院糖尿病专科护士采用“糖尿病健康教育执行单”对328例糖尿病患者进行糖尿病教育管理,以健康教育总评分的每33分位为界点﹝评分分别为(18.50±2.10)分、(24.70±1.70)分、(31.10±2.30)分﹞将糖尿病患者分为3组。比较3组患者的一般临床特征。方差及多元线性回归分析影响糖尿病教育管理临床效果的临床因素。结果糖尿病患者健康教育总评分不同,相应的年龄、文化程度、既往高血压病史、是否肥胖、体脂分布、糖尿病病程、糖化血红蛋白、血脂、住院天数存在差异( P<0.05)。多元线性回归分析结果显示,年龄、文化程度、既往高血压病史、糖尿病病程、体重指数均是影响糖尿病健康教育评分的因素,其中短病程、肥胖的老年糖尿病患者评分最低。糖尿病患者对基本治疗信息、饮食、运动、药物治疗的相关知识以及糖尿病并发症知识的掌握程度较差。结论年龄、文化程度、既往高血压病史、糖尿病病程、体质指数均是影响糖尿病健康教育评分的因素。对于短病程、肥胖老年患者应加强教育。健康教育相关糖尿病医学知识亦可影响教育评分。