老年2型糖尿病患者肌肉衰减现状及其糖尿病自我管理行为研究  

A study on the current status of sarcopenia and diabetes self-management behaviors in elderly patients with type 2 diabetes

作　　者：李敏 王丽[2] 屠馨怡 周菁颖 董颖越[5] 李菁 于康[6] Li Min;Wang Li;Tu Xinyi;Zhou Jingying;Dong Yingyue;Li Jing;Yu Kang(School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China;Fangzhuang Community Health Service Center,Fengtai District,Beijing 100078,China;the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;School of Nursing,Peking University,Beijing 100191,China;Department of Endocrinology,Peking Union Medical College Hospital,Beijing 100730,China;Department of Clinical Nutrition,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院护理学院,北京100144 [2]北京市丰台区方庄社区卫生服务中心,北京100078 [3]浙江大学医学院附属第二医院护理部,杭州310009 [4]北京大学护理学院,北京100191 [5]北京协和医院内分泌科,北京100730 [6]北京协和医院临床营养科,北京100730

出　　处：《中华临床营养杂志》2024年第2期71-79,共9页Chinese Journal of Clinical Nutrition

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-B-055);老年糖尿病合并肌肉衰减症患者跌倒风险及相关因素研究(PUMCSON202309)。

摘　　要：目的调查老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者肌肉衰减状况及自我管理的现状,探究糖尿病自我管理对肌肉衰减的危险因素识别情况。方法采用便利抽样法,选取2023年3至9月在北京市某社区卫生服务中心就诊的284例老年T2DM患者为研究对象,根据2019年亚洲肌少症工作组专家共识对患者进行肌肉衰减状况筛查和相关健康检查,采用一般资料调查表、糖尿病自我管理行为量表等进行问卷调查。根据患者是否存在肌肉衰减状况将其分为无肌肉衰减状况组和有肌肉衰减状况组。结果284例老年T2DM患者肌肉衰减状况的发生率为48.9%,肌少症的患病率为15.9%。有肌肉衰减状况组女性、70岁以上、有久坐习惯的患者占比显著高于无肌肉衰减状况组,优质蛋白摄入、四肢骨骼肌肌肉质量指数、握力、6 m步速显著低于无肌肉衰减状况组(P<0.05);二元Logistic回归分析显示年龄、饮酒情况、久坐、优质蛋白摄入是老年T2DM患者肌肉衰减状况的影响因素(P<0.05);两组在自我管理行为总分和运动维度得分的差异有统计学意义(P<0.05);单因素分析结果显示,不同握力和6 m步速患者的糖尿病自我管理行为差异有统计学意义(P<0.05);多元线性回归分析显示,握力和6 m步速是老年T2DM患者运动管理行为的影响因素(P<0.05)。结论老年T2DM患者肌少症的发生率较高,且其糖尿病自我管理水平中等偏下。在临床工作中,医护人员要更多关注70岁以上、有久坐习惯、优质蛋白摄入较少以及女性患者,建议通过握力和6 m步速测试对老年T2DM患者进行肌肉衰减状况的初筛,尽早识别风险并开展老年T2DM患者针对性的健康管理,促进患者良好自我管理行为的形成。Objective To investigate the current status of sarcopenia and self-management in elderly patients with type 2 diabetes mellitus(T2DM),and to explore the identification of risk factors for sarcopenia by diabetes self-management ability.Methods Using convenience sampling,284 elderly patients with T2DM who visited a community health service center in Beijing from March to September 2023 were selected as subjects.The patients were screened for sarcopenia and received related health examinations based on Asian working group for sarcopenia(AWGS)2019 Consensus.Surveys were conducted using general information questionnaire,the Summary of Diabetes Self-Care Activities measure,and other questionnaires.Patients were divided into groups according to the presence or absence of muscle attenuation(defined as suspected and confirmed sarcopenia).Results The prevalence of muscle attenuation in the 284 elderly patients with T2DM was 48.9%,and the prevalence of sarcopenia was 15.9%.The proportions of females,patients who are over 70 years old,and patients with a sedentary lifestyle were significantly higher in the group with muscle attenuation compared with the group without muscle attenuation.High-quality protein intake,extremity skeletal muscle mass index,grip strength,and six-meter walking speed were significantly lower in the muscle attenuation group.Binary logistic regression analysis revealed that age,alcohol consumption,a sedentary lifestyle,and high-quality protein intake were influencing factors for sarcopenia in elderly patients with T2DM(P<0.05).The total self-care scores and subtotals in exercise domains showed significant differences(P<0.05)between patients with and without muscle attenuation.Univariate analysis indicated significant differences in self-management behaviors among patient groups stratified by grip strengths and 6-meter walk speeds(P<0.05).Multivariate linear regression analysis showed that grip strength and 6-meter walk speed were influencing factors for exercise management behaviors in elderly patients

关 键 词：2型糖尿病 肌肉衰减 握力 6米步速 自我管理行为 

分 类 号：R473.5[医药卫生—护理学]