영양교육 및 상담이 제2형 당뇨병 환자의 영양지식, 식태도 및 영양섭취 상태에 미치는 효과

Abstract

This study aims to investigate the effects of education in nutrition and counselling on nutrition-related knowledge, dietary attitude and nutrient intakes of Type 2 diabetes patients. The subjects of the study were 100 patients who were over 20 years old and were hospitalized at K general hospital in Gwangju as they were diagnosed with diabetes or came to see the doctors because of diabetes. For the study, the general characteristics, diabetes control characteristics, health status, amount of knowledge on diet for diabetes control, manual diet practice, obstacles to practice, survey of nutrient intakes through the 24-hour recall method, and the post-effects of education in nutrition were analysed. The results are summarized as follows: The subjects were composed of 59 male patients and 41 females where 41% of all were between 50 and 64 years of age. For the prevalence of diabetes, 32% of patients had the disease for between 6 and 10 years. The overall fasting pre-blood glucose level was 198.1±88.5mg/dl, and fasting post-blood glucose level was 146.5±50.7mg/dL, which decreased significantly(p<0.001). The fasting pre-blood glucose level in male subjects was 212.3±93.9mg/dL while the fasting post-blood glucose level was 156.9±93.9mg/dlL. The fasting pre-blood glucose level in female subjects was 177.7±76.6mg/dL while the fasting post-blood glucose level was 131.4±37.9mg/dL, which decreased significantly(p<0.001). The overall HbA1c was 7.8±1.9% before education while it was 7.6±1.8% after education, which showed a significant decrease(p<0.001). The HbA1c in male subjects was 7.9±2.0% before education while it was 7.5±1.7% after education, which showed a significant decrease(p<0.001). Knowledge on diabetes increased significantly(p<0.001). As for questions on ‘food which diabetes patients are allowed to eat freely (free food)’, and ‘daily dietary calories,’ knowledge increased significantly(p<0.001). Knowledge on diabetes dietary behavior increased significantly(p<0.001). Knowledge on ‘whether you achieved your individual eating goal planned together with nutritionists' increased significantly(p<0.001). Most questions on the difficulties in diabetes practice showed significant differences(p<0.001), of which the question on ‘dietary therapy’ was significant(p<0.001). The total score for diabetes eating habits manual practice before education was 33.1±6.4 and the score after education was 50.3±5.0, which increased significantly(p<0.001). The diabetes eating habit practice score in male subjects before education was 33.3±6.5 and after education it was 50.9±5.0. which increased significantly(p<0.001). The diabetes eating habit practice scores in female subjects before education was 32.8±6.3 and it was 49.3±4.5 after education, which also increased significantly(p<0.001). The total mean value in obstacles to eating habit practice before education was 46.1±8.3 and it was 37.7±8.5 after education, which was significant(p<0.001). The mean value of obstacles in male subjects before education was 47.3±8.5 before education and it was 37.7±9.4 after education, which decreased significantly(p<0.001). The mean value of obstacles in female subjects before education was 44.7±7.9, and it was 37.7±7.0 after education, which decreased significantly(p<0.001). Nutrient intakes in male subjects before nutritional education was 1,541.7±158.3kcal and it was 1,333.7±87.5kcal after education, which decreased significantly by an average of 207.9 kcal(p<0.001). Carbohydrates at 258.7±19.2g before education significantly decreased to 219.7±16.2g after education(p<0.001). Lipids significantly decreased(p=0.006): being 28.9±9.2g before education and 25.7±5.6g after education. Protein significantly decreased(p<0.001): with 71.1±13.6g before education and 64.7±9.5g after education. The ratio of energy in carbohydrates, protein and fat(C:P:F) was: 65.8:17.9:16.3 before education and 64.8:18.7:16.8 after education. The intake rate of carbohydrate decreased, and that of protein increased, each of which changed significantly (p=0.027, 0.024). Changes in nutrient intakes for female subjects before education was 1,517.5±131.3kcal and 1,339.5±103.2kcal after education showing a mean 178kcal decrease which was significant(p<0.001). Protein decreased significantly(p<0.001): 255.6±19.8g before education and 217.6±20.7g after education. The proper energy ratio of carbohydrate, protein and fat(C:P:F) was: C:P:F = 65.9: 17.9:16.2 before education and 63.4:19.1:17.5 after education. The intake rate of carbohydrate decreased while that of protein increased, each of which changed significantly (p=0.009, 0.008). In comparison with the estimated energy requirements for male subjects, was 79.3% before education which decreased significantly to 69.4% after education (p<0.001). Nutrients the subjects took below the average requirements were riboflavin, calcium, and magnesium. In contrast to the intake rate of riboflavin, with 98.0% before education and 89.6% after education showing a significant decrease(p=0.011). As for magnesium, results were 24.9% before education and 28.7% after education(p=0.016), but the subjects took less than the average requirement. For sodium, the subjects took 297% of the target before education and 277% after education, which decreased significantly(p=0.017) and it was discovered that they still had excessive intake of it. Subjects who were suspected of deficits in thiamine showed 5.1% before education and 22.0% after education, which increased significantly(p=0.021). For niacin, the subjects took in 5.1% before education and 22.0% after education, which increased significantly(p=0.013). In comparison the estimated energy requirements for female subjects, showed 78.4% before education and 98.1% after education, but there was no significant change. As they took riboflavin, calcium, and magnesium more than the average requirement, a deficit was suspected. In comparison with the average intake of riboflavin, there was a 98.2% intake before education and 93.5% after education. As for calcium, there was a 88.9% intake before education and 87.0% after education. the intake of magnesium was 23.9% before education and 26.6% after education. After education, the intake decreased, but there was no statistical difference. The subjects who were suspected of a deficit in thiamine significantly increased from 4.9% before education to 29.3% after education(p=0.002). The results above are summarized: for male subjects, the higher their financial and educational status, the greater the effect nutritional education for knowledge had on diabetes. The shorter the diabetes prevalence, and the higher the blood sugar during fasting, the higher the educational effect on knowledge of diabetes on dietary therapy. As for the practice of eating well for diabetes control, the higher the income level, the shorter the diabetes prevalence and the lower the blood sugar level during fasting and the significantly higher the educational effect. As for improvements in obstacles to diabetes dietary therapy practice, the lower the economic level, the significantly higher the educational effect. For female subjects, the higher the educational level according to economic level, the shorter the diabetes prevalence, and the higher the blood sugar during fasting, the significantly higher the effects of nutrition education on knowledge of diabetes on dietary therapy. As for diabetes control in dietary life practice, the higher the economic level, the shorter the diabetes prevalence, and the lower the fasting blood sugar was, the higher the educational effect. Regardless of educational level, the improvement was significantly high. As for improvements in obstacles to diabetes dietary therapy practice, the lower the fasting blood sugar, the significantly higher the improvement effect.|본 연구는 제2형 당뇨병 환자를 대상으로 영양교육 및 상담이 환자의 영양지식, 식태도, 영양섭취 상태에 미치는 효과를 알아보기 위해 광주광역시 소재 K종합병원에 당뇨로 진단받은 입원 또는 외래로 내원한 만 20세 이상 당뇨 진단 된 환자를 100명을 대상으로 일반적 특성, 당뇨병 관리 특성, 건강행태. 당뇨병 관리 식사요법 지식도, 식생활 지침 실천도, 실천 장애요인, 24시간 회상법을 통한 식이섭취조사, 교육 후 영양교육의 효과를 비교 분석하였다. 그 결과를 요약하면 다음과 같다. 대상자들의 남자 59명, 여자 41명으로 생애주기 연령 중 50-64세가 41%, 당뇨 유병기간은 6-10년이 32%로 가장 많았다. 공복 혈당은 전체는 사전이 198.1±88.5 mg/dl, 사후 146.5±50.7 mg/dl로 유의하게 낮아졌다(p<0.001). 남자의 공복 혈당은 사전이 212.3 ±93.9 mg/dl, 사후 156.9±93.9 mg/dl, 여자는 사전이 177.7±76.6 mg/dl, 사후 131.4±37.9 mg/dl로 유의하게 낮아졌다(p<0.001). 당화혈색소는 전체는 사전이 7.8±1.9 %, 사후 7.6±1.8%로 유의하게 낮아졌다(p<0.001). 남자의 당화혈색소는 사전이 7.9±2.0 %, 사후 7.8±1.9%, 여자는 사전이 7.5±1.7 %, 사후 7.4±1.6%로 유의하게 낮아졌다(p<0.001). 당뇨 지식도는 전체적으로 유의하게 증가하였으며(p<0.001), 그 중 ‘당뇨병 환자가 자유롭게 먹을 수 있는 식품(자유식품)’, ‘본인의 하루 섭취 열량’ 등의 문항 에서는 유의적으로 상승하였고(p<0.001), 당뇨 식행동도 전체가 유의적으로 증가하였으며(p<0.001)), 그 중 ‘영양사와 함께 계획한 개인 식사목표 내용을 수행여부는 유의적으로 상승하였다(p<0.001). 당뇨실천 어려움에 관한 문항도 대부분 유의하였으며(p<0.001), 그 중 ‘식사요법의 유무’의 문항에서 유의하였다(p<0.001). 당뇨 식생활지침 실천도는 총점 사전 33.1±6.4점, 사후 50.3±5.0점으로 조사되어 유의하게 상승하였다(p<0.001). 남자는 사전 33.3±6.5점, 사후 50.9±5.0점으로 유의하게 상승하였으며(p<0.001), 여자도 사전 32.8±6.3점, 사후 49.3±4.5점으로 유의하게 상승하였다(p<0.001). 당뇨식사요법 실천 장애요인은 총 평균 점수는 사전 46.1±8.3, 사후 37.7±8.5로 조사되어 유의하였다(p<0.001). 남성은 사전 47.3±8.5, 사후 37.7±9.4로 유의하게 감소되었으며(p<0.001), 여성도 사전 44.7±7.9, 사후 37.7±7.0로 조사되어 유의하게 감소되었다(p<0.001). 영양소 섭취량 변화는 남자의 경우 사전 1,541.7 ±158.3 kcal, 사후 1,333.7±87.5 kcal로 평균 207.9 kcal 유의하게 감소하였다(p<0.001). 탄수화물은 사전 258.7±19.2 g, 사후 219.7±16.2 g로 유의하게 감소하였다(p<0.001). 지질은 사전 28.9±9.2 g, 사후 25.7±5.6 g으로 유의하게 감소하였으며(p=0.006), 단백질은 사전 71.1±13.6 g, 사후 64.7±9.5 g으로 유의하게 감소하였다(p<0.001). 탄수화물: 단백질: 지방(C:P:F)의 에너지 적정비율은 사전 C:P;F = 65.8:17.9:16.3, 사후 64.8:18.7:16.8로 탄수화물의 섭취 비율은 줄어들었고, 단백질 섭취 비율은 늘어났으며, 각각 유의한 차이를 보였다(p=0.027, 0.024). 영양소 섭취량 변화가 여자는 사전 1,517.5±131.3 kcal, 사후 1,339.5±103.2 kcal로 평균 178 kcal 유하게 감소하였다(p<0.001). 탄수화물은 사전 255.6±19.8 g, 사후 217.6±20.7 g로 유의하게 감소하였다(p<0.001). 탄수화물: 단백질: 지방(C:P:F) 에너지 적정비율은 사전 C:P:F = 65.9: 17.9:16.2, 사후 63.4:19.1:17.5로 탄수화물의 섭취 비율은 줄어들었고, 단백질 섭취 비율은 늘어났으며, 각각 유의한 차이를 보였다(p=0.009, 0.008). 남자는 에너지 필요추정량 대비 사전은 79.3%, 사후는 69.4%로 유의하게 감소하였다(p<0.001). 평균필요량 미만 섭취하고 있는 영양소로는 리보플라빈, 칼슘, 마그네슘이었으며, 리보플라빈은 평균섭취량 대비 사전 98.0%, 사후 89.6%로 유의하게 감소하였다(p=0.011). 마그네슘은 사전 24.9%, 사후 28.7%로 유의하게 증가하였으나(p=0.016) 평균필요량 미만으로 섭취하였으며, 나트륨은 목표량의 사전 297%, 사후 277%로 섭취로 유의하게 감소하였나(p=0.017), 과잉으로 섭취하는 것으로 나타났다. 티아민의 결핍이 우려된 대상자는 사전 5.1%에서 사후 22.0%로 유의하게 증가하였고(p=0.021), 니아신의 경우 사전 5.1%에서 사후 22.0%로 유의하게 증가하였다(p=0.013). 여자는 에너지 필요추정량 대비 사전은 78.4%, 사후는 98.1%로 증가하였으나 유의적인 차이는 없었다. 리보플라빈, 칼슘, 마그네슘의 섭취량이 평균필요량 미만으로 섭취하고 있어 결핍이 우려되었으며, 리보플라빈은 평균섭취량 대비 사전 98.2%, 사후 93.5%, 칼슘은 사전 88.9%, 사후 87.0%, 마그네슘은 사전 23.9%, 사후 26.6%로 교육 후 섭취량이 감소하였으나 통계적인 차이는 없었다. 티아민의 결핍이 우려되는 대상자가 사전 4.9%에서 사후 29.3%로 유의하게 증가하였다(p=0.002). 이상의 결과 남자의 경우 경제수준이 높을수록 교육정도가 높을수록, 당뇨지식요법의 지식도의 영양교육 효과가 높았고, 당뇨 유병기간이 짧을수록, 공복혈당 수준이 높을수록 당뇨식사요법 지식도에 대한 교육효과가 높게 나타났다. 당뇨병관리 식생활지침 실천도는 소득수준이 높을수록, 당뇨 유병기간이 짧을수록, 공복 혈당이 낮을수록 교육효과가 유의적으로 높았다. 당뇨식사요법 실천 장애요인 개선도는 경제 수준 낮을수록 교육효과가 유의적으로 높게 나타났다. 여자의 경우 경제수준에 따라 교육수준이 높을수록, 당뇨 유병기간이 짧을수록, 공복 시 혈당 수준이 높을수록 당뇨식사요법 지식도에 대한 영양교육의 효과가 유의하게 높아졌으며, 당뇨병 관리 식생활 실천 정도는 경제수준이 높을수록, 당뇨유병기간이 짧을수록, 공복혈당이 낮을수록 교육의 효과가 크게 나타났으며, 교육정도에는 상관없이 개선효과가 유의적으로 높았다. 당뇨식사요법 실천 장애요인 개선정도는 공복 혈당이 낮을수록 개선효과가 유의하게 높았다.