| Objective:Renders the level of blood glucose self-management and comprehensive metabolic in patients with type 2 diabetes in third-class hospitals in this study area,and to reveal the main influencing factors of blood glucose control in low-income people with type 2 diabetes;To establish a baseline database of low-income people with type 2 diabetes,in order to provide the basis of evidence-based medicine,to achieve accurate individualized treatment of diabetic patients,and to provide a reference basis for the formulation of feasible evidence-based nursing intervention measures.Methods:This study adopted the sequential interpretation strategy in the mixed research method,and was carried out according to the quantitative-qualitative research order.At first,a cross-sectional survey was conducted through the questionnaire on the related factors of diabetes health education,the Diabetes Health knowledge and Behavioral ability scale and the Chinese version of Diabetes Distress scale.Collected basic population information of low-income patients with type 2 diabetes,past participation in diabetes health education,diabetes health knowledge,behavior management ability,psychological pain status;comprehensive biochemical metabolic index of patients and explored the factors affecting blood glucose.For the factors affected blood glucose,through the phenomenological research method of qualitative research,the glycosylated hemoglobin index was divided into two groups according to%,the interview outline was made,and the cases of each group were interviewed in semi-structured depth.Finally,combined with the results of quantitative studies and qualitative interviews for scientific analysis,objectively reveal the influencing factors of blood glucose management in low-income patients with type 2 diabetes.All data The collected data are encoded,checked,inputted and proofread by two people,and the database is established by Epidata3.1.Used SPSS22.0 for statistical analysis,including normality test,descriptive statistical analysis,nonparametric test of two independent samples,nonparametric test of multiple independent samples,binary logistic regression,drawing ROC curve and so on.In the qualitative study,the phenomenological method was used to conduct semi-structured in-depth interviews with 10 patients with good blood glucose control and 11 patients with poor blood glucose control.Claizzi’s seven-step analysis method was used to analyze the qualitative research data.Results:1.Results of quantitative studies: The rate of reaching the standard of the knowledge and behavior scale for low-income type 2 diabetes patients was only22.14%;23.69% of the patients had a moderate degree of psychological pain and needed clinical attention.The rate of reaching the standard of comprehensive metabolic in low-income patients with type 2 diabetes was very low: 26.41% of glycosylated hemoglobin,20.39% of blood pressure,18% of blood lipids,58.44% of BMI,and only 5 patients with comprehensive metabolism,accounted for 0.97%.Univariate and further binary Logstic regression analysis indicated that medication status,knowledge scale score,behavioral scale score and psychological distress scale score were independent influencing factors for Hb A1 c compliance in low-income T2 DM patients.By drawing the ROC curve,the critical points of the score of knowledge scale,behavior scale and psychological pain scale in whether the Hb A1 c is met or not were further calculated,and the critical points of the three scales affecting whether the Hb A1 c is met or not were obtained as 44.5,47.5 and 36.5respectively.68.7% of low-income patients with type 2 diabetes had not participated in diabetes-related knowledge training,and 81.6% of patients most want to acquire disease-related knowledge through the introduction of doctors,their most desired knowledge of diabetes management was the prevention and nursing of diabetic complications and nursing when they were uncomfortable.The main reason why they were unable to adhere to self-management methods such as diet,exercise,and drugs was the lack of corresponding knowledge.2.Results of qualitative interviews: Protective factors of blood glucose control:standardized self-management,including drugs,monitoring blood sugar,obtaining relevant knowledge of diabetes health education,understanding of diabetic complications,persisting in exercise,strict management of diet,regular review and comprehensive control;patients’ excellent personal character,individual characteristics,patients’ attitude towards disease,mood regulation;the support of good environmental factors.Risk factors of blood glucose control: lack of standardized and comprehensive self-blood glucose management,low blood glucose control rate;lack of knowledge related to diabetes health education,low awareness rate of blood glucose management and control;patients’ personal quality,disease attitude and other self-related factors;lack of environmental factors around patients,such as family,community support.Conclusion:The level of self-management knowledge and self-management ability of low-income type 2 diabetic patients was low,and the incidence of psychological pain related to diabetes was high,which needed clinical attention.the rate of reaching the standard of comprehensive metabolic of low-income patients with type 2 diabetes was very low,and the comprehensive metabolism of blood glucose,blood pressure and blood lipids accounted for only 0.97%.The medication status,knowledge scale score,behavior scale score and psychological pain scale score of low-income type 2diabetes patients were the main factors affecting whether the Hb A1 c reached or not.Patients’ standardized self-management,excellent personal quality and good environmental support were the protective factors to promote the saccharification standards.On the contrary,patients’ lack of standardized and comprehensive self-management,negative attitude to cope with the disease and lack of good environmental support are the adverse factors for blood glucose control.Low-income patients with type 2 diabetes were very lack of diabetes-related knowledge,and the access to knowledge was very limited,which was also an important factor leading to poor blood glucose control. |
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