2型糖尿病临床路径管理初探

Investigation on the Effectivity of Management of Clinical Pathway in Type 2 Diabetes Patients

目的:评估2型糖尿病患者实行临床路径管理一年半后的血糖达标与胰岛功能改善情况。方法:采用开放非随机自身对照研究方法,入组107例门诊2型糖尿病患者根据CDS指南按BMI≥24kg/m2为二甲双胍联合胰岛素增敏剂(A组),和BMI≤24kg/m2为二甲双胍联合胰岛素促泌剂(B组)。平均随访1.5年。观察两组治疗前后空腹血糖(FBG)、餐后2小时血糖(2hPBG)、糖化血红蛋白(HbA1c)、血脂(TG、LDL-C、HDL-C)、空腹胰岛素(FINS)、餐后2小时胰岛素(2hINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-IS)、胰岛素敏感指数(HOMA-IAI)的变化。结果:与治疗前相比,两组患者FBG、2hPBG、HbA1c均显著下降,差异具有统计学意义(P<0.05),两组治疗后糖化血红蛋白达标率均较基线时提高(55.5～70.37%,48.94～65.96%),增敏剂组治疗后HOMA-IR、HOMA-IAI与基线时相比,差异具有统计学意义(P<0.05)。促泌剂组治疗后,HOMA-IS、HOMA-IR以及HOMA-IAI与基线时相比,差异均有统计学意义(P<0.05～0.01)。结论:实行2型糖尿病临床路径管理后显著提高血糖的达标率并有利于改善胰岛功能。

Objective To observe the effect of the clinical management pathway on the glycemic control and pancreatic β cell function in type 2 diabetes patients.Methods An open controlled reality research method was adopted in this study.According to CDS guideline,107 Outpatients with type 2 diabetes were divided into two groups.Group A：BMI≥24Kg/m2,metformin plus insulin sensitizer agent was used,and group B：BMI≤24Kg/m2,metformin plus insulin secretion promoting agents was used.The average follow-up was 1.5 years.The fasting blood glucose （FBG）,2 hours postprandial blood glucose （2hPBG）,glycosylated hemoglobin A1c （HbA1c）,fasting insulin （FINS）,2 hours postprandial insulin （2hINS）、serum lipids （TG,LDL-C,and HDL-C）,HOMA-IR,HOMA-IS,and HOMA-IAI were compared between before （baseline） and after treatment for two groups.Results Compared to baseline,the levels of FBG、2hPBG、HbA1c were decreased significantly in both group A and B （P0.05）.The rate of good HbA1c control （HbA1c value 6.5%） was significantly increased （70.37% vs 55.5% in group A,65.96% vs 48.94% in group B,respectively）.HOMA-IAI were significantly increased（P0.05）while HOMA-IR decreased （P0.05） in Group A.HOMA-IAI and HOMA-IS were significantly increased while HOMA-IR decreased （P0.05～0.01） in Group B.Conclusions The rates of good control in HbA1c and pancreatic β cell function were significantly improved in patients with type 2 diabetes mellitus under the management of clinical pathway.