社区老年糖尿病患者的综合治疗

Community-based investigation for diabetes care in elderly patients

目的探讨以社区为基础、以全科医学理论为指导的老年人糖尿病治疗模式。方法采用全科医学与专科相结合的治疗模式，从社区选择老年糖尿病患者122例（全科组），另在医院糖尿病专科门诊选择老年糖尿病患者124例（专科组），只接受专科治疗；进行18个月治疗观察。结果18个月时，社区组血压、空腹血糖（FBG）、糖化血红蛋白（HbAlc）、尿白蛋白排泄率（UAER）和抑郁症患病率均显著低于基线，收缩压（137．0±20．9）mmHg对（133．3±12．9）mmHg（P〈0．01）；舒张压（78．1±12．0）mmHg对（73．2±7．5）mmHg（P〈0．01）；FBG（9．3±3．5）mmol／L对（7．7±2．5）mmol／L（P％0．01）；HbAlc（7．1±2．3）％对（5．9±1．9）％（P〈0．01）；UAER自然对数转换值（UAERLN）3．1±1．7对2．4±1．0（P〈0．01）；抑郁症患病率23．0％对9．8％（P〈0．01）。专科组仅FBG和UAERLn显著低于基线，FPG（11．2±4．0）mmol／L对（9．8±2．7）mmol／L（P〈0．05），UAERLN3．0±1．3对2．8±1．5（P〈0．01）；体质指数（BMI）则显著高于基线，（24．4±3．9）kg／cm^2对（26．2±3．7）kg／cm^2（P％0．01）；且专科组血压、FPG和HbAlc波动较大。结论以社区为基础，专科与全科医学相结合的治疗模式是一种有效的老年人糖尿病治疗的整合模式。

Objective To explore the model of community-based combination treatment with specialty and general practice for the elderly with diabetes mellitus （DM）. Methods One hundred and twenty two elderly diabetic patients in 4 communities who received therapies from endocrinologists and general practitioners were recruited as community group, and 124 elderly diabetic patients at hospital who received treatment from endocrinologists alone were enrolled as specialty group. A 18 month treating and monitoring were performed and the medical model was assessed. Results In community group, blood pressure （BP）, fasting plasma glucose （FPG）, glycosylated haemoglobin （HbAlc）, urinary albumin excretion rate （UAER） and depression prevalence after 18 months treatment were significant decreased compared with baseline [systolic pressure （137.0 ± 20. 9）mm Hg vs. （133.3±12.9）mm Hg（P〈0.05）,diastolic pressure （78. 1±12.0）mm Hg vs. （73.2±7.5） mm Hg（P〈0.05）, FPG （9.3±3.5）mmol/L vs. （7.7±2.5）mmol/L（P〈0.01）, HbAlc （7.1± 2.3）% vs. （5.9±1.9）% （P〈0.01）, UAER values transformed into natural logarithm（UAERLN ）3.1±1.7 vs. 2.4±1.0 （ P〈0.01 ）, depression prevalence 23.0%vs. 9. 8 % （P〈 0.01 ）. In specialty group, FPG and UAER were significantly decreased （P〈0. 05）, and body mass index （BMI） was significant increased at 18 months than baseline [FPG （11.2±4.0）mmol/L vs. （9.8±2.7）mmol/L （P〈0.05）, UAERLN 3.0±1.3 vs. 2.8±1.5（P〈0. 01）, BMI 24.4±3.9 vs. 26.2±3.7（P〈0.01）. UAERLN was significantly lower in community group than in specialty group at end of the trial （P〈0. 01）. There were larger fluctuations of BP and unsatisfactory control of HbAlc in specialty group. Conclusions Community-based combination treatment with specialty and general practice for diabetes mellitus in the elderly is an effective integration model for elderly diabetes care.