不同病程的2型糖尿病患者经标准化代谢性疾病管理后的代谢指标转归  

Metabolic outcomes of type 2 diabetes patients with different diabetic durations under the standardized metabolic disease management model

作　　者：杨嘉颖 龚昱嘉 赖梦宇 李娜[1] 张爱芳[1] 顾丽萍[1] 王育璠[1] 彭永德[1] Yang Jiaying;Gong Yujia;Lai Mengyu;Li Na;Zhang Aifang;Gu Liping;Wang Yufan;Peng Yongde(Department of Endocrinology and Metabolism,Shanghai General Hospital,Shanghai Jiaotong University,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院内分泌代谢科,200080

出　　处：《中华内分泌代谢杂志》2021年第2期106-113,共8页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81870610);2018年上海市科学技术委员会医学引导类科技项目(18411968800)。

摘　　要：目的探讨不同病程的2型糖尿病患者在接受标准化代谢性疾病管理1年后,其糖脂代谢相关指标转归及达标情况。方法(1)将2017年9月至2018年9月在上海市第一人民医院国家标准化代谢性疾病管理中心(MMC)的345例2型糖尿病患者纳入研究,根据患者病程,分为新诊断2型糖尿病组(病程≤1年)和长病程组(病程>1年),比较2组患者基线时一般情况、血压、血糖、血脂水平及其达标率,以及综合达标率(血糖、血压和血脂三项均达标);(2)所有患者均接受标准化代谢性疾病管理,比较治疗1年后上述代谢指标的转归及达标情况。结果(1)基线时,与长病程组相比,新发糖尿病组患者更年轻(P<0.01),糖负荷后2 h血糖水平较高[(15.20±5.26对13.68±4.94)mmol/L,P<0.01]。(2)经过1年标准化代谢性疾病管理后,总体体重、血压及糖脂代谢指标均显著改善。相较于长病程组,新发糖尿病组患者血糖控制更好[空腹血糖(6.27±1.56对7.63±2.08)mmol/L,P<0.01;糖化血红蛋白(6.33±0.96对7.23±1.37)%,P<0.01],且HOMA-β较高[(74.01±56.45对40.17±37.07)%,P<0.01]。两组患者血糖、血压、血脂达标率均明显上升,整体综合达标率由5.80%上升至24.06%,经过1年治疗后,与长病程组相比,新发糖尿病组患者综合达标率更高(24.73%对17.18%,P=0.087);血糖达标率84.62%对53.37%(P<0.01)。结论标准化代谢性疾病管理促进2型糖尿病患者血糖、血压、血脂全面改善,其中血糖改善最为显著。新发2型糖尿病组的综合代谢指标及血糖的达标显著优于长病程组。在今后的工作中应注重2型糖尿病的早期诊断与早期治疗,积极推广MMC模式,注重血糖和血压、血脂并举的综合管理,同时对于长病程组的患者给予更多教育与关注,提高其认识和治疗依从性,提升综合达标率。Objective To explore the metabolic outcomes of type 2 diabetes patients with different durations after 1 year treatment under the standardized metabolic disease management model.Methods(1)From September 2017 to September 2018,345 type 2 diabetes patients in the Standardized Metabolic Management Center(MMC)of Shanghai General Hospital were recruited and included in this research.They were divided into newly-diagnosed type 2 diabetes(duration≤1 year)and long-term groups(duration>1 year).The general characteristics,blood pressures,glycemic levels,lipids levels,control rates and comprehensive compliance rates(blood glucose,pressure and lipids all reached targets)were compared at baseline between 2 groups.(2)All patients underwent one year standardized management,and metabolic indicators mentioned above and control rates at the time were compared as well.Results(1)At baseline,compared with long-term group,patients in newly-diagnosed type 2 diabetes group were younger(P<0.01),and 2 h blood glucose level after glucose loading were higher[(15.20±5.26 vs 13.68±4.94)mmol/L,P<0.01].(2)After one year standardized management,body weight,blood pressure,glucose and lipids metabolism in all patients were significantly improved.Compared with patients in long-term group,newly-diagnosed type 2 diabetes patients achieved better glycemic level[fasting blood glucose(6.27±1.56 vs 7.63±2.08)mmol/L,P<0.01;glycated hemoglobin(6.33±0.96 vs 7.23±1.37)%,P<0.01],and had higher HOMA-β[(74.01±56.45 vs 40.17±37.07)%,P<0.01].The glycemic control,blood pressure and blood lipids control rates in both groups increased significantly in one year.Comprehensive compliance rate of the whole patients increased from 5.80%to 24.06%.The metabolism indexes of the newly-diagnosed type 2 diabetes group were better than those of the long-term group[comprehensive compliance rate:(24.73%vs 17.18%,P=0.087,glycemic control rate(84.62%vs 53.37%,P<0.01)].Conclusion Standardized metabolic disease management promoted the overall improvement in blood glucose,b

关 键 词：新诊断2型糖尿病 糖尿病病程 标准化代谢性疾病管理 综合达标率 

分 类 号：R587.1[医药卫生—内分泌]