基于老年综合评估评价的个案跟踪管理应用于老年2型糖尿病合并骨质疏松症患者中的效果

Application of case tracking management based on comprehensive geriatric assessment evaluation in elderly patients with type 2 diabetes mellitus and osteoporosis

目的探讨基于老年综合评估(comprehensive geriatric assessment,CGA)评价的个案跟踪管理在老年2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松症(osteoporosis,OP)患者中的应用效果。方法采用单盲、随机、对照设计方法,将2019年2月—2020年2月中国科学技术大学附属第一医院(安徽省立医院)收治的94例老年T2DM合并OP患者分为常规组和管理组,每组47例。常规组采用常规管理,管理组采用基于CGA评价的个案跟踪管理。比较两组患者管理前及管理1年后糖代谢指标及骨密度(bone mineral density,BMD)、管理期间并发症与骨折发生率、管理前及管理1年后生活质量。结果管理1年后,管理组空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 h postprandial blood glucose,2hPG)水平和糖化血红蛋白(hemoglobin A_(1c),HbA_(1c))均低于常规组,腰椎及股骨颈BMD均高于常规组,差异有统计学意义(P<0.05);管理期间,管理组骨折与并发症发生率均低于常规组,差异有统计学意义(P<0.05);管理1年后,管理组各维度和总体生活质量评分均高于常规组,差异有统计学意义(P<0.05)。结论在老年T2DM合并OP患者中应用基于CGA评价的个案跟踪管理,可改善患者的糖代谢,增加BMD,减少骨折与并发症发生,提高生活质量。

Objective To determine the effect of case tracking management based on comprehensive geriatric assessment(CGA)in elderly patients with type 2 diabetes mellitus(T2DM)and osteoporosis(OP).Methods Using a single-blinded,randomized,controlled design,94 elderly patients with T2DM and OP treated at The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from February 2019 to February 2020 were divided into routine and management groups with 47 patients in each group.The routine group received routine management and the management group received case tracking management based on a CGA evaluation.The glucose metabolism and bone mineral density(BMD)indices before and 1 year after management,the incidence of complications and fractures,and the quality of life before and 1 year after management were compared between the two groups.Results After management,the fasting plasma glucose(FPG),2 h postprandial blood glucose(2hPG),and hemoglobin A_(1c)(HbA_(1c))levels in the management group were lower than the routine group(P<0.05),while the BMD of the lumbar spine and femoral neck were higher than the routine group(P<0.05).During the management period,the incidence of fractures and complications in the management group were lower than the routine group(P<0.05).After management,the scores of each dimension and overall quality of life in the management group were higher than the routine group(P<0.05).Conclusions In elderly patients with T2DM and OP,case tracking management based on CGA can control glucose metabolism,improve the BMD,reduce fractures and complications,and improve the quality of life.