标准化代谢性疾病管理中心(1+X)新模式建设对区域性糖尿病管理的影响  

Exploration on the promotion of national standardized metabolic management center and its 1+X construction in the regional diabetes mellitus management under the standardized metabolic disease management model

作　　者：甄琴[1] 杨嘉颖 顾丽萍[1] 王育璠[1] 周毓旻 吴惠静 ZHEN Qin;YANG Jiaying;GU Liping;WANG Yufan;ZHOU Yumin;WU Huijing(Department of Endocrinology and Metabolism,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;Department of Medical Affairs,Shanghai General Hospital,Shanghai Jiao Tong 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,上海200080 [2]上海交通大学附属第一人民医院医务处,上海200080

出　　处：《世界临床药物》2021年第9期792-797,共6页World Clinical Drug

基　　金：松江区科学技术攻关项目(农业、医药卫生类)(19SJKJGG28)。

摘　　要：目的探究糖尿病(diabetes mellitus,DM)患者在接受标准化代谢性疾病管理后的糖脂代谢相关指标转归及达标情况,并深入分析标准化代谢性疾病管理中心(national standardized metabolic management center,MMC)和上海市松江地区MMC(1+X)模式对区域性DM慢性疾病管理模式的推动作用。方法纳入2017年6月至2020年6月我院MMC随访半年的DM患者1 593例,随访1年的DM患者958例,2019年12月至2020年6月松江地区MMC(1+X,1为MMC中心,X为基层社区医院)社区的DM患者217例。所有患者均接受标准化代谢性疾病管理。收集我院MMC的DM患者基线时期、随访半年及1年后、社区的DM患者基线时期及随访半年后的一般资料、血压、血糖、血脂水平及其达标率,比较上述指标转归及达标情况。结果在我院MMC接受管理的DM患者中,与基线时期比较,随访半年及1年后的血清糖化血红蛋白、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇较管理前均下降,且较基线时期差异分别有统计学意义(P<0.05);高密度脂蛋白胆固醇、收缩压、舒张压、体质量指数无明显变化(P>0.05);所有患者代谢指标达标率明显改善,随访半年及1年后血糖达标率明显升高(P<0.05);所有患者血脂达标率升高(P<0.05);血压、体质量达标率无明显变化(P>0.05);管理半年及1年后综合达标率升高(P<0.05)。在松江地区MMC(1+X)社区患者中,随访半年者糖化血红蛋白、空腹血糖下降(P<0.05);总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、收缩压、舒张压、体质量指数无明显变化(P>0.05);血糖、血压、血脂达标率均有上升,综合达标率及BMI达标率无明显变化(P>0.05)。结论 MMC管理模式可显著改善DM患者糖脂代谢指标,将该管理模式推广至松江各社区和基层单位,即MMC(1+X)管理模式,有望有效地推动松江区域性慢性疾病的管理水平,具有重要价值。Objective To explore the prognosis and compliance of glycolipid metabolism related indicators in patients with diabetes mellitus(DM) after receiving standardized metabolic disease management,and in-depth analysis of national standardized metabolic management center(MMC) and MMC(1+X,1 is MMC center,and X is grass-roots community hospital) model in Songjiang area of Shanghai to promote the regional chronic disease management model of DM.Methods A total of 1 593 patients with DM managed for half a year and 958 patients managed for one year in MMC of our hospital from June 2017 to June 2020 and 217 patients with DM in MMC(1+X) community in Songjiang area from December 2019 to June 2020 were included.All patients received standardized metabolic disease management.The general data,blood pressure,blood glucose,blood lipid levels and their compliance rates during the baseline period,half a year and one year after follow-up were collected,and the same data of DM patients in the community during the baseline period and half a year after follow-up was collected.The outcomes and compliance of the above indicators were compared.Results Compared with the baseline period,the serum glycosylated hemoglobin,fasting blood glucose,total cholesterol,triacylglycerol and low density lipoprotein cholesterol in patients with DM with MMC in our hospital decreased after half a year and one year of follow-up,and the differences were statistically significant compared with the baseline period(P<0.05).There were no significant changes in high density lipoprotein cholesterol,systolic blood pressure,diastolic blood pressure and body mass index(P>0.05).The metabolic index compliance rate of all patients was significantly improved,and the blood glucose compliance rate increased significantly after half a year and one year of follow-up(P<0.05).The blood lipid standard rate increased in all patients(P<0.05).There was no significant change in blood pressure and body mass compliance rate(P>0.05).The comprehensive compliance rate increased after half

关 键 词：标准化代谢性疾病管理模式 糖尿病 慢性疾病管理 综合达标率 

分 类 号：R781.64[医药卫生—口腔医学]