分级诊疗模式影响2型糖尿病患者血糖控制水平的临床疗效  

Influence of hierarchical diagnosis and treatment pattern on glycemic control in patients with type 2 diabetes mellitus

作　　者：杨晓园 李会敏[1] 李静[1] 毋中明[1] 

机构地区：[1]天津医科大学代谢病医院内分泌研究所,卫生部激素与发育重点实验室,天津市代谢性疾病重点实验室,天津市300070

出　　处：《世界华人消化杂志》2016年第19期3072-3076,共5页World Chinese Journal of Digestology

摘　　要：目的:观察分级诊疗模式对血糖水平控制良好的2型糖尿病患者的影响.方法:将253例糖化血红蛋白A1c(glvcated hemoglobin A1c,HbA1c)<7.0%的18-70岁2型糖尿病患者随机分为分级诊疗组(HDT组,123例)和对照组(130例).分级诊疗组于居住地就近选择基层医疗卫生机构接受常规降糖诊疗,对照组于天津医科大学代谢病医院门诊接受常规降糖诊疗,共12 wk.治疗前后观察研究对象的运动情况,测定并比较两组体质量指数(body mass index,BMI)、腰围(waist circumference,WC)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP),抽取静脉血检测空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2h postprandial plasma glueose,2h PPG)、HbA1c、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、甘油三酯(triglycerides,TG)水平.结果:治疗前后两组HDL-C和LDL-C无明显变化.12 wk后对照组运动情况有所改善.FPG、2h PPG、HbA1c、BMI、WC、SBP、DBP、TG均有所降低,分别为6.65mmol/L±0.79 mmol/L、10.74 mmol/L±1.14mmol/L、6.27%±0.47%、25.57 kg/m^2±2.39kg/m^2、85.50 cm±5.14 cm、136.32 mmHg±10.92 mmHg、82.55 mmHg±10.04 mmHg、1.79 mmol/L±0.43 mmol/L.而HDT组略有升高,分别为6.76 mmol/L±0.88 mmol/L、10.77 mmol/L±1.04 mmol/L、6.40%±0.43%、25.78 kg/m^2±2.47 kg/m^2、85.60 cm±5.40 cm、137.01 mmHg±11.22 mmHg、83.21 mmHg±9.90 mmHg、1.81 mmol/L±0.43 mmol/L.血糖控制达标(HbA1c<7.0%)率分别为98.46%和95.93%,但两组间差异无统计学意义,并且与治疗前比较差异亦无统计学意义.12 wk后对照组FPG、2 h PPG、HbAlc、BMI、WC、SBP、DBP、TG均有所降低,而分级诊疗组略有升高,血糖控制达标(HbA1c<7.0%)率分别为98.46%和95.93%,但两组间差异无统计学意义,并且与治疗前比较差异亦无统计学意义.结论:分级诊疗模式可以应用于在三级医院就诊的血糖水平控制良好的2型�AIM：To investigate the effect of hierarchical diagnosis and treatment pattern on wellcontrolled glycemic level in patients with type2 diabetes mellitus（T2DM）.METHODS：A total of 253 T2 DM patients aged between 18 and 70 years with glycated hemoglobin A1c（HbA1c） 7.0%were randomly divided into a hierarchical diagnosis and treatment group（HDT group,n- 123）and a control group（n = 130）.The HDT group received conventional hypoglycemic treatment in their nearest primary health care institutions,while the control group accepted treatment for12 wk in Tianjin Medical University Metabolic Diseases Hospital which was a tertiary hospital.The primary end point was glycemic level,which was measured by comparing fasting plasma glucose（FPG）,2 h postprandial plasma glucose（2 h PPG） and HbA1 c at the baseline and the end of treatment.Body mass index（BMI）,waist circumference（WC）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C） and triglyceride（TG） were assessed as secondary end points.RESULTS：HDL-C and LDL-C of two groups showed no statistical significance at the end of the study.FPG,2 h PPG,HbA1 c,BMI,WC,SBP,DBP and TG of the control group were6.65 mmol/L ± 0.79 mmol/L,10.74 mmol/L ±1.14 mmol/L,6.27%± 0.47%,25.57 kg/m^2 ± 2.39kg/m^2,85.50 cm ± 5.14 cm,136.32 mmHg ± 10.92 mmHg,82.55 mmHg ± 10.04 mmHg and 1.79mmol/L ± 0.43 mmol/L,respectively.They were all decreased after a 3 mo follow-up period.However,these parameters in the HDT group were elevated slightly to 6.76 mmol/L± 0.88 mmol/L,10.77 mmol/L ± 1.04 mmol/L,6.40%± 0.43%,25.78 kg/m^2 ± 2.47 kg/m^2,85.60 cm ± 5.40 cm,137.01 mmHg ± 11.22 mmHg,83.21 mmHg ± 9.90 mmHg,and 1.81 mmol/L± 0.43 mmol/L,respectively.The proportions of patients with well-controlled glycemic level（HbAlc 7.0%） were 98.46%and 95.93%,respectively.There were no significant difference between the two groups and between baseline and the end of

关 键 词：分级诊疗模式 2型糖尿病 血糖水平 

分 类 号：R587.1[医药卫生—内分泌]