【作者】 张琦；

【导师】 鞠昌萍；

【作者基本信息】 东南大学 ， 护理学（专业学位）， 2018， 硕士

【摘要】 研究目的评价手机App干预对2型糖尿病病人的糖代谢、脂代谢、自我效能、抑郁状况方面的短期、中期、长期的效果。研究方法本研究为随机对照试验。于2016年10月~2017年4月选取在某三甲医院内分泌科门诊就诊并符合纳入标准的2型糖尿病病人共150例,其中互动式手机App组、手机App组和常规组各50例。干预时间为12个月,常规组研究对象给予五个半天的糖尿病健康教育及每四周一次的电话访问;App组研究对象在常规教育的基础上提供下载简版App(即无医护患线上交流板块);互动式App组研究对象在常规教育的基础上下载具有医护患互动功能的App。三组分别在干预前、干预后3个月、干预后6个月、干预后12个月面访时测量空腹血糖、早餐后2h血糖、糖化血红蛋白、血脂以及填写自我效能量表、抑郁量表,对研究对象的血糖代谢、血脂代谢、自我效能及抑郁情况进行测量和评价。评估手机App对2型糖尿病病人的短期、中期及长期的有效性和可行性。研究结果1.本研究三组共完成141例研究对象的全部资料收集,其中互动式App组45例,App组47例,常规组49例。三组研究对象之间的基线资料差异无统计学意义(P>0.05)。2.干预后三组的组间比较显示:(1)干预后3个月时,三组间在血糖代谢、自我效能得分、抑郁得分方面均无统计学意义(P>0.05);脂代谢方面,互动式手机App组的低密度脂蛋白和总胆固醇均低于App组,差异有统计学意义(P<0.01);App组低密度脂蛋白和总胆固醇均高于常规组,差异有统计学意义(P<0.05),其余各项脂代谢指标比较均无统计学意义(P>0.05)(2)干预后6个月,三组间在血糖代谢、自我效能得分、抑郁得分方面均无统计学意义(P>0.05);互动式App组总胆固醇低于常规组,差异有统计学意义(P<0.05),其余脂代谢指标组间比较均无统计学意义(P>0.05)。(3)干预后12个月时,互动式手机App组在糖代谢、自我效能得分方面均优于App组且App组优于常规组,差异有统计学意义(P<0.05)。在脂代谢、抑郁得分方面,三组间差异无统计学意义(P>0.05)。3.三组自身前后比较显示:(1)互动式手机App组,糖代谢、自我效能得分方面,在各时间点差异均有统计学意义,干预后12个月效果均最好;在脂代谢、抑郁方面,干预后3个月时,低密度脂蛋白、甘油三酯、总胆固醇、抑郁得分均低于干预前,差异有统计学意义(P<0.05),其余时间点差异均无统计学意义(P>0.05)。(2)App组,干预后3个月,在糖代谢、脂代谢、自我效能得分、抑郁得分方面均优于干预前,差异有统计学意义(P<0.05)。在干预后6个月时,空腹血糖、自我效能得分方面均优于干预前及干预后3个月,差异有统计学意义(P<0.05),其余各项指标仅与干预前相比具有统计学意义。在干预后12个月时,早餐后2h血糖、糖化血红蛋白均优于干预后6个月、干预后3个月及干预前,差异有统计学意义(P<0.05);空腹血糖、自我效能得分、抑郁得分均优于干预后3个月及干预前,与干预后6个月相比差异无统计学意义(P>0.05)。(3)常规组,干预后3个月,在糖代谢、脂代谢(除高密度脂蛋白)、自我效能得分、抑郁得分方面均优于干预前,差异有统计学意义(P<0.05)。干预后6个月、12个月时,在空腹血糖、早餐后2h血糖、血脂代谢、抑郁得分方面仅优于干预前,差异有统计学意义(P<0.05);糖化血红蛋白、自我效能得分方面优于干预前及干预后3个月,差异有统计学意义(P<0.05)。研究结论1.在本研究中,手机App在长期内能改善2型糖尿病病人的血糖控制情况。2.在本研究中,手机App在长期内能提高2型糖尿病病人的自我效能。3.在本研究中,手机App干预过程中体现了医护患互动式信息反馈的重要性。4.在本研究中,手机App未能改善病人的抑郁情绪,其应用效果仍有待进一步探讨。5.在本研究中,手机App未能改善病人的血脂情况,其应用效果有待进一步论证。更多还原

【Abstract】 Purpose: To evaluate the short-term,medium and long-term effects of mobile phone application intervention on glucose metabolism,lipid metabolism,self-efficacy and depression in patients with type 2 diabetes mellitus.Methods: A randomized controlled trial was used in this study.From December,2016 to April,2017,type 2 diabetes patients was selected from the department of endocrinology,affiliated to the university of southeast university of jiangsu province.The sample contained 150 patients with type 2 diabetes and met the inclusion criteria,and were divided into three subgroups.The conventional group(n=50)were given five half-day diabetes health education and telephone interviews every four weeks.The App group(n=50)downloaded the reversion App(no medical treatment lines on line)on the basis of the routine group education.The interactive App group was used to download the App and patient interaction on the basis the routine group education.Three groups respectively before the intervention,intervention for 3 months,6months intervention,intervention 12 months when measuring fasting blood glucose,blood sugar 2 hours after breakfast,glood lipid and fill in the self-efficacy scale,depression scale.To measure and evaluate the blood sugar metabolism,blood lipid metabolism,self-efficacy and depression in the study subjects,and assess the efficacy and feasibility of moile phone applicition for the short-term,medium and long-term of the type 2 diabetes patients.Results1.A total of 150 subjects completed all data collection,45 cases of the interactive App group,47 cases of the App group,and 49 cases of the conventional group.No significant differences were found between three subgroups at baseline(P>0.05).2.The comparison between the three groups shows: (1) After 3 months of intervention,between the three groups in glucose metabolism,self-efficacy score,depression score has no statistical significance(P>0.05);In lipid metabolism,the low-density lipoprotein and total cholesterol in the interactive App group were lower than the App group,and the differences were statistically significant(P<0.05).The low density lipoprotein and total cholesterol in the App group were higher than those in the conventional group,and the difference was statistically significant(P<0.05),and the remaining lipid metabolism was not statistically significant(P>0.05).(2) After 6months of intervention,there was no statistically significant difference between the three groups in blood glucose metabolism,self-efficacy score and depression score(P>0.05);The total cholesterol of the interactive App group was lower than that of the conventional group,and the difference was statistically significant(P<0.05),and the comparison between the remaining lipid metabolism group was not statistically significant(P>0.05).(3) After 12 months of intervention,interactive App group in blood glucose metabolism,self-efficacy scores were better than that of the App and App group is superior to the conventional group,the difference was statistically significant(P<0.05).There was no statistically significant difference between the three groups in fat metabolism and depression score(P>0.05).3.Compared to baseline: (1)In the interactive mobile phone App group,the score of glucose metabolism and self-efficacy was statistically significant at all time points,and the effect was the best in 12 months after intervention.In terms of lipid metabolism,depression,3 months after intervention,low density lipoprotein,triglyceride,total cholesterol and depression scores are lower than before the intervention,the difference was statistically significant(P<0.05),the rest of the time point difference had no statistical significance(P>0.05).(2)In the App group,glucose metabolism,lipid metabolism,self-efficacy score and depression score was superior to baseline in the three months after intervention,and the difference was statistically significant(P<0.05).At 6 months after intervention,fasting glucose,self-efficacy scores are better than the baseline and 3 months,the difference was statistically significant(P<0.05),the rest of the indicators only statistically significantcompared with the baseline.After 12 months of intervention,2h blood glucose and glycosylated hemoglobin were better than 6 months,3 months and baseline,and the difference was statistically significant(P<0.05).Fasting blood glucose,self-efficacy score and depression score were all better than 3 months and baseline,and there was no statistically significant difference between 6 months after intervention(P>0.05).(3)In the routine group,after the intervention for 3 months,the score of glucose metabolism,lipid metabolism(except high-density lipoprotein),self-efficacy score and depression score were all superior to baseline,and the difference was statistically significant(P<0.05).After 6months and 12 months intervention,the fasting blood glucose,2h after breakfast blood sugar,blood lipid metabolism,depression score only better than the baseline,the difference was statistically significant(P<0.05);The protein hemoglobin and self-efficacy scores are better than the baseline and three months after the intervention,and the difference is statistically significant.(P<0.05).Conclusions:1.The mobile phone application can improve blood glucose control in patients with type 2 diabetes in the long term.2.The mobile phone application can improve the self-efficacy of patients with type 2 diabetes in the long term.3.The mobile phone application intervention shows the importance of the patient’s interactive feedback.4.In this study,the mobile phone application failed to improve the type 2diabetes patient’s depression,It is worthy of further research to study whether the mobile App can improve patients’ depression.5.In this study,In this study,mobile phone App failed to improve the blood lipid profile of type 2 diabetes patients,its application effect needs to be further demonstrated.更多还原