| Objective: Explore the intervention effect on the nutrition and diet knowledge,attitude and behavior of type2diabetic patients of the nutrition education combining balanceddiet with glycemic index (GI) and glucose load (GL), promote the process of making theideas of GI and GL as important contents of diabetes nutrition education, and providereference for effectively implement diabetes nutrition and diet education and intervention.Method: Independently design questionnaire of DIABETES NUTRITION ANDDIET KNOWLEDGE-ATTITUED-BEHAVOIR SURVEY, which includes diabetesnutrition and diet knowledge, diet behavior, life style, attitude on diet and life style.Randomly select hospitalized type2diabetic patients as survey targets. Explainstudy target, meaning and questionnaire filling method. Hand out first batch ofquestionnaires after the targets know the facts and agree to participate in the survey,then fill the questionnaires by face-to-face inquire or letting the targets to fill theirquestionnaires themselves and collect the filled questionnaires on spot. After the firstsurvey, diet nutrition education is implemented and second batch of questionnaire arehanded out by using the same questionnaire, and then the questionnaires are collectedon spot. Altogether278valid questionnaires are collected.Education contents include diabetes balanced nutrition and rational dietknowledge, food glycemic index, food glucose load, rational life style, etc.Education modes adopt integrated intervention mode combining group classroomeducation, team education, individualization instruction, written education data.Education data includes diet guide of Chinese residents and balanced diet pagodaof Chinese residents, glycemic index table, glucose load table (self-made), pictures offigure dialogue, food cards and object teaching aids, etc.Valid questionnaire adopts SPSS16.0software to make statistic analysis. Thecomparison between the measurement data before and after the education adoptst-inspection, and the comparison of rate adopts χ2-inspection.After getting the scores of50articles on diabetes nutrition and diet knowledge before and after the education, the scores are divided into three levels, including low(＜60points), medium (60~80points) and high (＞80points), and then averagescores before and after education are worked out. According to scientific principle ofdiabetes diet and life style, intervention effect analysis evaluation is implemented onthe diet behavior, life style, diet and life style of survey targets.Result:1. Nutrition education can effectively improve the diabetes nutrition anddiet knowledge level of diabetic patientsBefore education, many diabetic patients have lower awareness rate on diabetesnutrition and diet knowledge, their knowledge with awareness rate of less than50%includes the followings, diabetes diet control does not only mean the intake ofprinciple food and sweet food, eating more pumpkins and bitter gourds cannot curediabetes, trace element chromium cannot cure diabetes, porridge shall not be stopped,vegetables and potatoes shall not be cut up too much, the decision value of abdominalobesity provided by China, core of “rational nutrition”, best food source of calcium,influence of drinking with an empty stomach on the bodies of diabetic patients, dailyintake amount of cooking oil for common adults, food with low GI and low GL isgood for glucose control, the GI of cornflakes is higher than boiled corn, the GI ofwheat soda biscuits is higher than oat meal biscuits, rich milk and skim milk are bothfood with low GI, types of porridges with low glucose index, decision value of foodwith “high glucose load”, etc.Most of all, only around10%of the diabetic patients know the decision value ofabdominal obesity provided by China, appropriate daily intake amount of cooking oil,decision value of food with “high glucose load”.The awareness rate of the diabetic patients on the following knowledge is higher,including using insulin shall also control diet, limit amount of “sugar-free snacks”,diabetic patients shall not only have vegetarian diet and their principal food shallinclude appropriate coarse food and fine food, etc. Their awareness difference beforeand after education is not obvious (P＞0.05), but for other diet knowledge, theawareness rate after education is higher than the one before education(P＜0.05).The score result of diabetes nutrition and diet knowledge show that thepercentage of patients with high score is less than10%before education, most of themare in medium and low level, and the percentage of patients in low level is higher than 1/2, but after education, the percentage of patients with high score is nearly90%.For the average score of diabetes nutrition and diet knowledge, the score beforeeducation is58.1and the score after education is91.7, so the score after education ismuch higher than the score before education (P＜0.001).2. Nutrition education can effectively improve recognition rate on active dietand life style attitudeAfter education, the number of diabetic patients who think rational diabetes dietprinciple are also suitable for non-diabetic patients, are willing to actively understanddiabetes nutrition treatment knowledge, insist on diet treatment for a long time, arewilling to understand diet guide and balanced diet pagoda of Chinese residents, arewilling to adopt food diversity, take grains as principal food, have milk, beans or beanproducts every day and have bland diet with less salt and change bad eating habits,hope to use glycemic index and glucose load to guide diet, hope that food label canshow the glycemic index and glucose load of food, are confident to implementrational exercise in a persistent way and reach and keep appropriate body weight isobviously increased (P＜0.01).After education, the number of patients who adopt diet control as the most basicmeasure in complex diabetes treatment is increased (P＜0.001), the number ofpatients who choose food according nutritive value, glycemic index and glucose loadis increased and the number of patients who choose food according to taste and priceis reduced (P＜0.01), more people have active and positive attitude on relevantdiabetes knowledge education, and especially after education, more people urgentlywant to know the knowledge about glycemic index and glucose load (P＜0.005), andmore patients hope to get nutrition knowledge through nutrition clinic, medical carepersonnel, normal lecture and consultation (P＜0.05).3. Nutrition education is good for correcting the diet behavior of diabeticpatients.Types of daily food intake: Before education, the percentage of patients who canhave11～15types or more than15types of food each day is less than15%, andaround43.2%and42.8%of patients have5～10types or less than5types of foodeach day. After education, The number of patients who have11～15types,16～20types or21～25types of food each day is increased (P<0.001). Diet composing: Before education, the percentages of diabetic patients whohardly have milk and coarse food are43.9%and29.9%, the percentages of patientswho hardly have poultry meat, fishes, shrimps and crabs, beans and bean products andfruits are all more than10%, and around5.8%of diabetic patients do not have eggs.After education, the numbers of patients do not have livestock meat, poultry meat,fishes, shrimps and crabs, milk, eggs, beans and bean products, fruits and coarse foodare all reduced(P<0.001).Daily fruits intake frequency shows that13.3%of the diabetic patients hardlyhave fruits before education, and after education, the number of patients who hardlyhave fruits is reduced (P＜0.001). The percentage of the patients who have fruitsevery day is changed from25.5%before education to78.8%after education, and thedifference before and after education is obvious (P＜0.001).Daily vegetables intake amount shows that45%of the patients has less than300g of vegetables before education, and the percentage of patients who have300g ormore of vegetables reaches to94.2%(P＜0.01).After education, the number of patients who hardly have livestock meat isreduced (P＜0.005), and the number of patients who have1time of livestock meateach week is increased (P＜0.005). Before and after education, the percentage ofpatients who have2～3times of livestock meat each week is the highest, which isfollowed by the patients who have1time of livestock meat each week, and thepatients who have4～6times of livestock meat each week.After education, the numbers of patients who have4～6times of fishes, shrimpsand crabs each week and have fishes, shrimps and crabs every day are both increased(P＜0.001), the numbers of patients who have4～6times or2～3times of poultrymeat each week and have poultry meat every day are both increased (P＜0.05), thenumbers of patients who have3～4eggs and5～7eggs each week are both increased(P＜0.01), the percentage of patients who have300g or more of milk every day isincreased from less than20%before education to43.2%, the number of patients whoonly have coarse food is reduced (P＜0.05), the number of patients who have50g～100g of coarse food every day is increased (P＜0.001) and the number of patientswho have beans and bean products every day is increased (P＜0.001). Breakfast having situation: Before education, the percentage of patients who havebreakfast every day is87%, and after education, all of the diabetic patients can have breakfastevery day, so the difference before and after education is obvious (P＜0.001).Diet habit: After education, the number of patients with light tastes is increased(P<0.001), and the numbers of patients who have high salt diet, like greasy food,snacks, fat meat and have more livestock than poultry, fishes and shrimps are reduced(P<0.001).Dining habit: After education, the number of people who have more meals a daybut less food at each, have quantitative meals on time, chew carefully and swallowslowly is increased (P<0.001), and the number of people who have two meals a day,often have overeating behavior and have faster eating speed is reduced (P<0.001).The results show that education has promotion effect on diabetic patients inhaving diversified food, improving diet structure and changing bad eating habits.4. Nutrition and diet education is good for the compliance on healthy lifestyle of diabetic patientsExercise (practice) situation: The percentage of patients who hardly haveexercise (practice) is changed from19.4%before education to1.8%after education,and the percentage of patients whose exercise time≥150minutes is changed from42.8%before education to75.2%after education, so the difference is obvious(P<0.001).Exercise time: After education, the number of patients who have exercise withempty stomach and before meal is reduced (P<0.001), the number of patients whohave30minutes～1hour of exercise after meal is increased (P<0.001) and thepercentage of patients who participate in exercise with medium intensity is increased(P<0.001).Smoking situation: The percentage of patients who smoke at least one package ofcigarettes is changed from20%before education to1.8%after education, thepercentage of patients who smoke at least half package of cigarettes is changed from9.0%before education to2.2%after education and the percentage of patients who donot smoke or quit smoking is changed from66.9%before education to81.3%aftereducation, so the difference before and after education is obvious (P<0.01).Drinking situation: After education, the number of patients who drink every dayor nearly every day or more than2times each week is reduced (P<0.01), and the number of people who quit drinking is increased (P<0.01).Drinking amount of each time: At present, the percentage of male diabeticpatients whose drinking amount is more than “2units of alcohol” is reduced(P<0.001), and at present, the percentage of female diabetic patients whose drinkingamount is less than “1unit of alcohol” is increased (P<0.005).Conclusion:1. Adopting the mode of combining group classroom education, team education,individualization instruction, written education data and object teaching aids andimplementing nutrition and diet education combining balanced diet with glymericindex and glucose load can effectively improve the nutrition and diet knowledge levelof diabetic patients, improve recognition rate of active diet and life style attitude, aregood for correcting the diet behavior of diabetic patients and are good for thecompliance on healthy life style of diabetic patients.2. Nutrition education is an effective method for improving the knowledge,attitude and practice on nutrition and diet of diabetic patients, and nutrition and dieteducation shall be taken as one regular measure in the clinical treatment ofhospitalized diabetic patients3. Diabetic patients urgently want to understand nutrition and diet knowledge,especially the knowledge about glymeric index and glucose load, and they have activeattitude towards diet treatment and nutrition education. On the basis of balanced dietknowledge education, GI knowledge and GL knowledge are used in the diet guide ofdiabetic patients through combination, which are easy to be accepted by diabeticpatients. It is suggested that glymeric index idea and glucose load idea are used asimportant contents in diabetes nutrition and diet education4. At present, the knowledge level on nutrition and diet of diabetic patients needsto be improved, their diet practice needs to be corrected, special attention shall be paidto the long-term of diabetes nutrition and education and diabetes nutrition and dietguide shall be strengthened. |
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