大同市糖尿病流行特征及中西医社区综合干预效果评价

The Epidemic Characteristics of Diabetes in Datong City and the Evaluation of Comprehensive Intervention Effect of Chinese and Western Medicine in Community

目的了解大同市糖尿病流行现状,评价社区干预效果,探索社区干预新方法、新模式。方法采用分层整群随机的方法,抽取30～73岁居民2586人进行问卷调查及医学体检,对207名糖尿病患者实施血糖监测、规律运动、药物优化等指导以及中医体质辩识和调控的综合干预,比较干预前后行为改变及血糖、血压、总胆固醇(TC)、甘油三酯(TG)及体质指数(BMI)等指标的变化。结果大同市30～73岁居民糖尿病患病率为9.90%,标化率为7.76%,空腹血糖受损(IFG)患病率为8.76%,标化率为5.92。糖尿病患病率随年龄的增长而上升。中医阳明、厥阴体质者糖尿病和IFG的患病率高于其他体质类型。药物优化(40.09%)、血糖监测(29.46%)及主动运动(59.90%)与干预前(分别为25.12%,15.94%,32.36%)比较,差别有统计学意义(P<0.01),血糖、血脂、血压及BMI均下降。结论在常规干预的基础上,中医药的介入对在血糖、TC、TG、血压及BMI的控制有明显效果,将中医药引入社区干预体系对提升糖尿病综合防控水平有积极意义。

Objective To understand the epidemic characteristics of diabetes in Datong, to evaluate the intervention effect in communities and to probe the new intervention methods and models. Methods By adopting multiple stages cluster sampling method, 2 586 residents aged 30-73 yrs were conducted a survey of diabetes and the medical examination, and 207 patients with diabetes were selected and implemented the integrated guidance of blood glucose monitoring, regular exercise and optimizing medications as well as the body constitution identification and adjustment by Chinese medicine, and compared the changes of behavior, blood glucose, blood pressure, total cholesterol （TC）, TG, BMI and other indicator of change between before and after intervention. Results The diabetes prevalence of population aged 30-73 yrs was 9.90%, and the standardized rate was7.76%. The IFG rate was 8.76% and its standardized rate was 5.92%. Both rates above in urban area were higher than those in rural area, the rate of new diagnosed diabetic eases reached to 42%, it was higher in urban area than in rural area. The diabetes prevalence of population increased with age and family income, physical index was direcdy proportional to DM. The prevalence rates of DM and IFG in people with the Yang ruing and Jue ying physical constitution were obviously higher than those of other physical types. There were significance in the rates of optimum mediations, regularly blood sugar monitoring and active exercise between after and before intervention （40.09% vs 25.15%, 29.46% vs 15.94%, 59.90% vs 32.36%, all P〈0.01）, and the blood sugar, blood Lipids, blood pressure and BMI declined. Conclusion On the basis of the routine intervention, treatment with the traditional Chinese medicine has the control of blood sugar, blood lipids, blood pressure and the BMI, and the traditional Chinese medicine has important role in the synthesized prevention and control in improving DM.