数字化延续随访结合BCW理论在T2DM患者随访管理中的应用

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[中图分类号]R4 [文献标识码]A [文章编号]1672-4062（2026）02（a）-0153-05

Application of Digital Continuous Follow-up Combined with BCW Theory in the Follow-up Managementof T2DM Patients

HE Guoqin

BaoyingCounty People'sHospital ofYangzhou City，Yangzhou 2258Oo，Jiangsu，China [Abstract]Objective To explore theapplication efectof digital continuation follow-upcombined with the BCW theory inthe follow-upmanagementof patients with type2 diabetes mellitus （T2DM）.Methods 2OO patients with T2DMadmited to Baoying CountyPeople's Hospital of Yangzhou City in Jiangsu Province from May to October 2025 were convenientlyselected.Theywere divided into thecontrol groupand the study group according todiferent ntervention methods，with 1OO cases in each group. The control group received the current routine discharge follow-up care inthe hospital.Thestudy group adoptedthedigitalcontinuation care planbased onthe BCW theory framework. The blood glucose levels，disease knowledge awareness，self-effcacy，and total medication compliance were compared.Results After the nursing，the fasting plasma glucose and glycated hemoglobin Alc of the study group were lower than those of the control group，and the differences were statistically significant （all P <0.05）. After the nursing， thescoresof disease knowledge awarenessand self-efficacyinthe study group were higherthanthose in thecontrol group，and the differences were statistically significant （all P<0.05 ）. The total medication compliance of the study group was higher than that of the control group，and the difference was statistically significant （ P <0.05）. Conclusion Digital continuous follow-upcombined with the BCW theorycan effectivelycontrol thedaily blood glucose levels，improve patients'awareness of disease knowledge and self-eficacy，and enhance medication compliance in the followup management of T2DM patients.

[Keywords] Digital follow-up;Behaviour change wheel theory; Type2 diabetes mellitus

糖尿病作为多并发症且需终身管理的慢性代谢性疾病，给患者个人、家庭及医疗卫生系统均带来了沉重负担[]。（剩余6030字）