| Objectives1.To understand the current situation and factors influencing the glycaemic management of elderly patients with type 2 diabetes in the community.To investigate the relationship between self-management ability,diabetes self-efficacy,patient motivation,health beliefs and glycosylated haemoglobin levels in elderly type 2 diabetic patients.2.To construct an intelligent diabetes management model supported by community telemedicine based on health beliefs theory,and to evaluate the effects of intelligent blood glucose management on glycated haemoglobin levels,diabetes self-management ability,self-efficacy,patient motivation and health beliefs in elderly type 2 diabetic patients(Type 2 Diabetes Mellitus,T2DM)in the community.Methods1.From January 2022 to April 2022,211 elderly patients with type 2 diabetes mellitus were recruited as respondents in Wenfeng Street Community Health Service Center,Yangzhou City,Jiangsu Province,according to the nano-exclusion criteria,using laboratory tests,a general information questionnaire,the Summary of Diabetes Self-Care The survey used laboratory tests,general information questionnaires,the Summary of Diabetes Self-Care Activities Measure(SDSCA),the Patient Activation Measure(PAM-13),the Self-efficacy for Diabetes(SED),and the Health Beliefs Questionnaire to assess the socio-demographic and disease-related information,glycaemic red blood cells,and the health beliefs of elderly patients with type 2 diabetes.The PAM-13,the Self-efficacy for Diabetes(SED),and the Health Beliefs Questionnaire were used to assess socio-demographic and disease-related information,glycated haemoglobin,diabetes self-management ability,self-efficacy,patient motivation and health beliefs of older people with type 2 diabetes.2.From April 2022 to October 2022,198 elderly type 2 diabetic patients were recruited for a randomized controlled experimental study in Wenfeng Street Community Health Service Centre,Yangzhou City,Jiangsu Province,according to the nano-exclusion criteria,and the subjects were randomly divided into 99 cases each in the control and intervention groups using the random number table method.The control group received conventional diabetes management in the community,while the intervention group was given intelligent diabetes management based on health beliefs for 6 months on top of the control group.The levels of glycosylated haemoglobin,diabetes self-management ability,self-efficacy,patient motivation and health beliefs were compared between the two groups at 3 months and 6 months after the intervention,and adverse events during the intervention period were observed and recorded.3.SPSS 27.0(version 27.0 Chicago,IL,USA),GraphPad Prism(version 9.4.1)and R Language(version 4.0.3 R Core Team)software were used for data analysis.Statistical methods included:descriptive analysis,non-parametric tests,independent samples t-test,one-way ANOVA,Pearson correlation analysis,chi-square test,linear regression,generalised estimating equation(GEE)and repeated measures ANOVA with P<0.05 being statistically significant.Results1.Study of the current status and factors influencing home blood glucose management in elderly patients with type 2 diabetesThis investigation was conducted on 211 elderly type 2 diabetic patients included in the study.The population had glycosylated haemoglobin(7.27±2.48)%,fasting glucose(7.98±2.03)mmol/L and postprandial glucose(11.94±3.17)mmol/L.This indicated that elderly type 2 diabetic patients had poor glycaemic control.The mean diabetes self-management ability score was(21.70±5.07),with the lowest score dimension being smoking status(1.88±2.30)and the highest score dimension being general diet(5.44±1.91).The mean self-efficacy score was(25.85±4.17),with 15,6%(33/211)of the patients scoring at the low self-efficacy level.The mean patient motivation score was(46.42±7.67),with 1.9%(4/211)of the patients scoring at the fourth level.The mean score for health beliefs was(70.72±6.35),with the lowest and highest dimensions being perceived impairment(5.64± 1.60)and perceived benefit(26.72± 1.76)respectively.Significant correlations were found between glycosylated haemoglobin levels and diabetes self-management ability,self-efficacy,patient motivation and health beliefs.The results of univariate analysis showed that glycosylated haemoglobin levels in older patients with type 2 diabetes were associated with gender,work status,diabetes self-management ability,self-efficacy,patient motivation and level of health beliefs(P<0.05).Multiple linear analysis showed that gender,work status,diabetes self-management,self-efficacy,patient motivation and health beliefs were factors influencing glycosylated haemoglobin levels in older people with type 2 diabetes(F= 8.930,P<0.001),explaining 48.4%of the total variance.2.Effectiveness of an intelligent diabetes management programme based on health beliefs in older patients with type 2 diabetes(1)Before the intervention,there were no statistically significant differences in the general demographic data,glycated haemoglobin,diabetes self-management ability,self-efficacy,patient motivation and health belief levels between the two groups(P>0.05),indicating that the two groups were comparable.(2)GEE analysis showed that:(ⅰ)Pairwise comparisons at each time point within the group:in the intervention group,all pairwise comparisons of glycosylated haemoglobin levels at 2 time points after intervention were statistically significant(P<0.001)and decreased at the 6-month time point compared to the 3-month time point.In the control group,glycosylated haemoglobin levels were only reduced after the intervention,and although there was a reduction in glycosylated haemoglobin levels at the 6-month time point compared to baseline,the difference was not statistically significant(P>0.05).(ⅱ)Pairwise comparisons between groups at each time point:the differences in glycosylated haemoglobin levels between the two groups were statistically significant(P<0.01)at 3 and 6 months after intervention,with the intervention group being lower than the control group.(ⅲ)There was no interaction between time and group(P=0.131).(3)Repeated measures ANOVA showed that diabetes self-management ability,self-efficacy,patient motivation and health beliefs were significantly improved in both groups,with patients in the intervention group improving more than those in the control group.After 6 months of the intervention with intelligent diabetes management based on health beliefs,there were significant differences in self-management ability(P<0.01),self-efficacy(P<0.01),patient motivation(P<0.01)and health beliefs(P<0.01)between the two groups.(4)Adverse events:No serious adverse clinical events were reported in both groups from enrolment to 6-month follow-up.Conclusion1.Poor glycaemic control was prevalent in elderly patients with type 2 diabetes in the community to varying degrees.Gender,work status,diabetes self-management ability,self-efficacy,patient motivation and health beliefs were factors influencing glycaemic control in older patients with type 2 diabetes.2.Health education based on the health belief model improved the self-management ability of elderly type 2 diabetic patients,increased patient self-efficacy,motivated patients,and overall improved patients’ health beliefs,further enhancing elderly patients’ knowledge,confidence and skills in using intelligent devices.3.Intelligent diabetes management based on health beliefs can theoretically achieve comprehensive,accurate and timely diabetes self-management at home for elderly type 2 diabetic patients,help realise the spread of telemedicine technology among elderly type 2 diabetic patients,provide elderly type 2 diabetic patients with new options to prevent disease progression and treatment,and provide medical professionals with a more convenient way to manage diabetic patients. |
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