中青年2型糖尿病患者出院后自我管理轨迹变化与影响因素分析-现代医学

中青年2型糖尿病患者出院后自我管理轨迹变化与影响因素分析

单位：1. 江苏省人民医院宿迁医院内分泌科, 江苏宿迁 223800;
2. 江苏省人民医院宿迁医院护理部, 江苏宿迁 223800

分类号：R587.1

出版年·卷·期（页码）：2025·53·第十期（1562-1568）

摘要：

目的：探讨中青年2型糖尿病患者出院后自我管理轨迹变化，并分析其潜在类别和影响因素。方法：采用纵向研究设计，纳入2023年6月至2024年6月在我院就诊的180例中青年2型糖尿病患者为研究对象，随访调查患者出院后1年内自我管理情况。采用潜变量增长混合模型(LGMM)分析自我管理变化轨迹及类别，根据收集的临床资料，采用Logistic回归分析潜在类别的影响因素。结果：180例患者中最终168例患者完成研究。出院后中青年2型糖尿病患者自我管理行为评分随出院时间延长呈下降趋势。经LGMM分析，最终选择保留3个潜在类别作为最优模型，分别为高水平上升组(40例、占23.81%)、中水平维持组(59例、占35.12%)、低水平下降组(69例、占41.07%)。3个轨迹组年龄、文化程度、家庭人均月收入、合并症、居住方式、疾病知识得分及家庭关怀度指数比较，差异均有统计学意义(均P＜0.05)；Logistic回归分析显示，以低水平下降组为对照，年龄、疾病知识得分、家庭人均月收入、合并症、家庭关怀度指数为中水平维持的影响因素；以中水平维持组为对照，疾病知识得分、家庭人均月收入为高水平上升的影响因素(P＜0.05)。结论：中青年2型糖尿病患者出院后自我管理行为评分随院外时间延长呈下降趋势，有高水平上升、中水平维持、低水平下降3种轨迹趋势，其中年龄、疾病知识得分、家庭人均月收入、合并症、家庭关怀度指数为中水平维持的影响因素，疾病知识得分、家庭人均月收入为高水平上升的影响因素，临床可针对上述因素制定针对性措施提高患者自我管理行为水平。

Objective: To investigate the trajectory changes of self-management in young and middle-aged patients with type 2 diabetes mellitus after discharge and analyze their latent classes and influencing factors. Methods: Using a longitudinal study design, 180 young and middle-aged patients with type 2 diabetes mellitus treated in our hospital from June 2023 to June 2024 were included as study subjects. Follow-up surveys were conducted on patients' self-management status within one year after discharge. Latent Growth Mixture Model(LGMM) was used to analyze self-management trajectory changes and classes. Based on collected clinical data, Logistic regression analysis was used to analyze influencing factors of latent classes. Results: Among 180 patients, 168 patients ultimately completed the study. Self-management scores of young and middle-aged patients with type 2 diabetes mellitus showed a declining trend with prolonged time after discharge. Through LGMM analysis, three latent classes were finally selected and retained as the optimal model: high-level rising group(40 cases, 23.81%), medium-level maintaining group(59 cases, 35.12%), and low-level declining group(69 cases, 41.07%). Significant differences were found among the three trajectory groups in age, education level, monthly family income per capita, comorbidities, living arrangements, disease knowledge scores, and family care index(all P<0.05). Logistic regression analysis showed that, with the low-level declining group as reference, age, disease knowledge scores, monthly family income per capita, comorbidities, and family care index were influencing factors for medium-level maintenance; with the medium-level maintaining group as reference, disease knowledge scores and monthly family income per capita were influencing factors for high-level rising(P<0.05). Conclusion: Self-management behavior in young and middle-aged patients with type 2 diabetes mellitus shows a declining trend with prolonged time outside the hospital after discharge, presenting three trajectory patterns: high-level rising, medium-level maintaining, and low-level declining. Among these, age, disease knowledge scores, monthly family income per capita, comorbidities, and family care index are influencing factors for medium-level maintenance, while disease knowledge scores and monthly family income per capita are influencing factors for high-level rising. Targeted measures can be developed clinically based on the above factors to improve patients' self-management behavior.

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