综合管理有助于1型糖尿病血糖控制  

Disease-management programs improve glycemic control in type 1 diabetic patients

作　　者：邢晓欢[1] 严晋华[1] 杨黛稚[1] 李津[1] 邓洪容[1] 章燕[1] 姚斌[1] 翁建平[1] 

机构地区：[1]中山大学附属第三医院内分泌及代谢病科,广州510630

出　　处：《中华糖尿病杂志》2013年第5期275-278,共4页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然青年科学基金（81100556）;广东省科技计划项目（20108031500008）;广东省自然科学基金项目（S2011010005078）;中山大学临床医学研究5010计划项目（2007030）;中山大学青年教师培育项目（2009-2012）

摘　　要：目的探讨综合管理对1型糖尿病（T1DM）血糖控制的影响。方法纳入2010年8月6日至2013年1月1日在中山大学附属第三医院就诊随访的T1DM患者，实施综合管理，包括3个月1次的规律随访、糖尿病教育、治疗方案调整及免费的糖化血红蛋白（HbAlC）检测等。根据HbAlc是否达到相应年龄段的血糖控制目标将患者分为达标组和未达标组。采用logistic回归模型分析HbAlC达标与各因素的相关性。结果共纳入144例T1DM患者，男64例，女80例，中位年龄29．0岁（四分位间距22．0，38．0，下同），糖尿病病程4．5年（2．8，9．0），体质指数（BMI）19．8kg／m^2（18．9，22．0），干预前HbAlc8．2％（6．7％，9．8％），41例（28．5％）HbAlc达标。完成3、6、9、12个月随访的患者分别为97、50、44、36例，HbAlC达标率分别为50．5％、80％、77％、63．9％。随访3、6、9、12个月HbAlc分别为7．2％（6．4％，8．3％）、7．2％（6．6％，7．9％）、7．0％（6．4％，7．7％）、7．0％（6．5％，8．0％），与干预前比较差异均有统计学意义（均P〈0．05）。Logistic回归分析显示年龄较大、BMI较小、自我血糖监测（SMBG）频率较高的和病程较短的患者血糖控制较好。结论综合管理有助于T1DM的血糖控制，增加自我血糖监测频率对血糖控制有利。Objective To investigate the effect of disease-management programs on glycemic control in type 1 diabetic （T1DM） patients. Methods T1DM patients registered in the Third Affiliated Hospital of Sun Yat-sen University from August 6, 2010 to January 1, 2013 were enrolled and disease-management programs were implied in those patients, including scheduled follow-up every 3 months, diabetic education, treatment plan adjustment and free glycated hemoglobin A1 c （HbAlc） test in each visit. The patients were divided into two groups according to the HbAlc level： those whose HbAlc reached the control standard and those not. Multivariate logistic regression analysis was used to investigate the correlative factors for control effect of HbAlc. Results Total of 144 T1DM patients were enrolled, among them 64 were male, 80 were female, the patients aged 29. 0 years （interquartile range：22. 0, 38.0, same below） with a T1DM duration of 4.5 years （2.8, 9.0） and a body mass index （BMI） of 19.8 kg/m^2 （18.9, 22.0）. The HbAlc at baseline was 8.2% （6. 7% , 9. 8% ） and 41 patients （28.5%） achieved the age-specific HbAlc targets after the therapy. The number of patients completed the 3-, 6-, 9- and 12-month follow-up was 97, 50, 44 and 36, respectively. And of them, 50. 5%, 80%, 77%, 63.9% reached the age-specific glycemic control goals at the 3-, 6-, 9- and 12-month visit, respectively. HbAlc fell from 8.2 （6. 7%, 9. 8% ） at baseline to 7.2% （6. 4%, 8.3%） at3-month, 7.2% （6. 6%,7.9%） at6-month, 7.0% （6. 4%,7.7%） at 9- month and 7.0% （6.5%, 8.0% ） at 12-month （all P 〈 0. 05 compared with baseline）. Binary logistic regression analysis showed that patients who were older, with lower BMI, more frequent self-monitoring of blood glucose（SMBG） and shorter diabetic duration had better glycemic control. Conclusions Disease- management programs has a favorable effect on glycemic control in T1DM patients. Higher frequency of SMBG is beneficial for glycemic improvement.

关 键 词：糖尿病 1型 血红蛋白A 糖基化 血糖自我监测 疾病管理 

分 类 号：R587.1[医药卫生—内分泌]