社区“5＋1”分阶段糖尿病达标管理模式对2型糖尿病患者的干预效果及其影响因素研究  

Intervention Effect of Community“5 + 1” Staged Diabetes Target Management Mode on Patients With Type 2 Diabetes Mellitus and Its Influencing Factors

作　　者：娄青林[1] 卞茸文[1] 刘冬梅[1] 欧阳晓俊[1] 顾刘宝[1] 俞匀[1] 巫海娣[1] 卢甜甜[1] 胡艳[1] 陈吉海[1] 代玲俐[1] 庄永忠 许家仁[1] 

机构地区：[1]江苏省省级机关医院糖尿病防治研究中心糖尿病防治、教育、研究国际合作中心,江苏省南京市210024 [2] 南京市鼓楼区卫生局

出　　处：《中国全科医学》2015年第22期2713-2717,2726,共6页Chinese General Practice

基　　金：国家自然科学基金面上项目(71373132);江苏省基础研究计划(自然科学基金)重点项目(BK2010089)

摘　　要：目的了解社区"5+1"分阶段糖尿病达标管理模式("5+1"模式)对2型糖尿病患者的干预效果,并探讨其影响因素。方法于2011年6月,在南京市鼓楼区所辖的11个社区卫生服务中心抽取符合本研究纳入及排除标准的2型糖尿病患者2 621例。剔除数据不完整和随访时间不足1年的患者,最终纳入患者1 488例。所有患者均采用"5+1"模式进行随访干预,中位随访干预时间为24个月。分别收集患者管理前、基线、第1次随访、年度随访及末次随访资料,包括患者及其糖尿病管理者的一般资料,患者各项代谢指标、治疗方案、阿司匹林使用率、血糖达标率、血脂达标率、血压达标率、主要代谢指标检测率及常见并发症筛查率等。结果 (1)患者末次随访的糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、收缩压、舒张压、总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)与基线比较,差异有统计学意义(P<0.01);而BMI和高密度脂蛋白胆固醇(HDL-C)与基线比较,差异无统计学意义(P>0.05)。(2)患者末次随访的治疗方案和阿司匹林使用率与基线比较,差异有统计学意义(P<0.01)。(3)基线、第1次随访、年度随访、末次随访,患者血糖达标率比较,差异有统计学意义(P<0.05);第1次随访、年度随访及末次随访血糖达标率与基线比较,差异均有统计学意义(P<0.008 3)。基线、第1次随访、年度随访、末次随访,患者血压达标率比较,差异有统计学意义(P<0.05);第1次随访、年度随访及末次随访血压达标率与基线比较,差异均有统计学意义(P<0.008 3)。基线、第1次随访、年度随访、末次随访,患者血脂达标率比较,差异无统计学意义(P>0.05)。(4)管理前、第1次随访及年度随访,患者Hb A1c、血压、LDL-C检测率比较,差异均有统计学意义(P<0.05);尿蛋白/肌酐比值、眼底、足病及心电图筛查率比较,差异亦均有统计学意义(P<0.Objective To explore the intervention effect of community ＂5 ＋ 1＂ staged diabetes target management mode on patients with type 2 diabetes mellitus and its influencing factors. Methods In June 2011, we enrolled 2 621 patients with T2DM who accorded with the inclusion and exclusion criteria from 11 community health service centers administrated under Gulou District in Nanjing. After the exclusion of patients with incomplete data and with follow -up less than one year, we finally included 1 488 subjects. All patients were administrated with ＂5 ＋ 1＂ staged diabetes target management, and the median time range for follow - up and intervention was 24 months. We collected data of subjects before intervention, at baseline, and during the first follow - up visit, the annual follow - up visit and the last follow - up visit. The data included general data, various metabolic indexes, treatment regimen, the usage rate of aspirin, the rates of blood glucose, blood lipid and blood pressure reaching standard, the detection rates of major metabolic indexes and screening rates for common complications. Results （ 1 ） HbAIo, FPG, 2 hPG, systolic pressure, diastolic pressure, TC, TG and LDL - C were lower （P 〈0. 01 ） in the last follow - up visit than baseline, while BMI and HDL - C in the last follow - up visit were not significantly different （ P 〉 0. 05 ） from baseline. （2） Treatment regimen and the usage rate of aspirin in the last follow - up visit were significantly different （ P 〈 0. 01 ） from baseline. （3） There was significant difference （P 〈 0. 05 ） in the rate of blood glucose reaching standard among baseline, the first follow - up visit, the annual follow - up visit and the last follow - up visit ; the rates of blood glucose reaching standard of the first follow - up visit, the annual follow - up visit and the last follow - up visit were significantly different （ P 〈 0. 008 3 ） from baseline. There was significant difference （ P 〈 0. 05 ） in the rate of blood pre

关 键 词：“5+1”分阶段糖尿病达标管理模式 糖尿病 2型 疾病管理 影响因素分析 

分 类 号：R587.1[医药卫生—内分泌] R197[医药卫生—内科学]