摘要
背景我国糖尿病的发病率迅猛发展且呈年轻化趋势,糖尿病及其并发症降低了患者生活质量,给家庭和社会带来了巨大的经济负担,科学的管理方式是预防和控制并发症发生、发展的关键环节。近年来提出的国家标准化代谢性疾病管理中心(MMC)是全新的管理模式,使糖尿病患者得到了有效管理。目的探讨MMC在糖尿病患者管理中的应用效果。方法本研究采用方便取样的方法,选择2017年7月-2019年1月在大连医科大学附属第一医院内分泌科住院的140糖尿病患者为研究对象。随机分为对照组(n=70)和试验组(n=70)。对照组接受常规入院全面评估和常规出院个性化指导。试验组在对照组的基础上出院后即进入MMC进行随访管理。在干预前和干预1年后采用糖尿病自我管理行为(SDSCA)量表对患者自我管理能力进行评价;在干预前和干预后6个月、1年分别检测空腹血糖(FPG)和餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)和血脂指标〔三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕。结果本研究纳入的140例糖尿病患者中途失访9例,最终纳入试验组66例、对照组65例。干预1年后,对照组饮食、运动、血糖监测、足部护理、药物依从性及SCSCA量表总分低于试验组(P<0.05)。时间因素、干预方式因素在FPG、2 hPG、HbA1c上主效应显著(P<0.05),时间因素、干预方式因素在FPG、2 hPG、HbA1c上存在交互作用(P<0.05)。干预1年后,试验组TG、LDL-C低于对照组(P<0.05);干预1年后,两组TC和HDL-C比较,差异无统计学意义(P>0.05)。结论MMC管理模式提高了糖尿病患者的自我管理能力,能够降低患者的FPG、2 hPG和HbA1c,改善患者TG、LDL-C水平。
Background The incidence of diabetes in China is growing rapidly,and is increasingly occurring in young people.Diabetes and diabetes-related complications impair patients'quality of life,and impose great economic burden on patients'families and society.Scientific management is essential to the prevention,and control of diabetes-related complications incidence and development.The national metabolic management center(MMC),a new management mode developed recently,can effectively management diabetic patients.Objective To evaluate the management effect of MMC in patients with diabetes.Methods By use of convenience sampling,140 diabetic inpatients were recruited from Department of Endocrinology,the First Affiliated Hospital of Dalian Medical University from July 2017 to January 2019,and were stratified into the control group(n=70),and experimental group(n=70).Both groups received routine comprehensive assessment after admission and routine post-discharge individual guidance,and the experimental group additionally received MMC during the post-discharge followup period.Intervention results were evaluated by self-management level assessed by the Summary of Diabetes Self-Care Activities(SDSCA)measure at the end of 1-year intervention,and 3 glycemic parameters〔fasting plasma glucose(FPG),2-hour postprandial glucose(2 hPG),glycosylated hemoglobin(HbA1c)〕,and 4 lipid parameters〔triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)〕measured at the end of 6-month and 1-year intervention.Results After excluding 9 cases who lost to follow up,the remaining 131 cases(66 in the experimental group and 65 in the control group)were included in the analysis.After 1 year of intervention,the experimental group obtained much better results in terms of diet control,exercise,blood glucose monitoring,foot care,drug compliance and SCSCA scale score(P<0.05).The main effects of the period and mode of intervention on FPG,2 hPG and HbA1c were significant(P<0.05).And there was interaction between the period and mode of intervention on FPG,2 hPG and HbA1c(P<0.05).After 1 year of intervention,TG and LDL-C levels in the experimental group were more lower(P<0.05),but TC and HDL-C levels were similar in both groups(P>0.05).Conclusion Routine management plus MMC enhances the self-management level,reduces the levels of FPG,2 hPG and HbA1c,and improves TG and LDL-C levels in diabetic patients.
作者
殷慧慧
杜建玲
王艾红
门莉莉
陈正女
安丽
YIN Huihui;DU Jianling;WANG Aihong;MEN Lili;CHEN Zhengnyu;AN Li(Department of Endocrinology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)
出处
《中国全科医学》
CAS
北大核心
2020年第15期1928-1932,共5页
Chinese General Practice
基金
大连市科技创新基金项目(2018J13SN098)。
关键词
糖尿病
疾病管理
自我管理
血糖自我监测
Diabetes mellitus
Disease management
Self-management
Blood glucose self-monitoring
