糖尿病患者社区强化管理和治疗--300例随访54个月的效果评价

Effectiveness evaluation of an intensified community-based treatment and management in 300 diabetic patients through 54 months of follow-up

目的对社区300例糖尿病患者强化管理和治疗的效果评价。方法糖尿病患者300例随机分为强化治疗组(n=145)和标准治疗组(n=155),对强化组进行强化综合干预、强化控制达标、规范随访;标准组给予常规门诊治疗管理,为期54个月。结果强化组与标准组比较,干预后18个月HbA_1c、胆固醇、LDL-C达标率显著升高(分别为55.8% vs 29.9%,68.8% vs 56.5%,74.2% vs 54.0%,P<0.05);干预后36个月和54个月,强化组较标准组HbA_1c达标率显著升高(36个月为73.1% vs24.3%,54个月为80.3%υs 24.6%,P<0.05)。强化组入组前和干预后18个月、36个月、54个月4次比较,血压、空腹血糖、HbA_1c、胆固醇、HDL-C、用药情况及月花费差异均有统计学意义(P<0.05)。血压达标率4次分别为57.6%、59.3%、60.5%、83.1%;HbA_1c为46.2%、55.8%、73.1%、80.3%;胆固醇为42.1%、68.8%、63.2%、62.9%;HDL-C为70.5%、87.5%、81.6%、81.4%。入组后18个月强化组双胍类药物所占比例较标准组少(56.1%υs 67.3%,P<0.05);磺脲类和胰岛素明显增加(分别为70.2%υs54.0%,21.3% vs 12.0%,P<0.05);降糖药月花费强化组增加134.5元,上升53.6%,标准组增加70.5元,上升29.8%。结论社区强化干预可以使血糖得到良好控制,血压、血脂较理想控制,花费略增。

Objective To evaluate the effects of an intensified community-based management and treatment on abnormal levels of glucose, blood pressure and lipids in 300 diabetic patients. Methods The study included an intensified management group （n= 145） and conventional treatment group （n= 155）. The intensified group was treated with strengthened comprehensive intervention, self blood glucose monitoring, and regular visit at least once a month, while the conventional group was treated as usually in the community medical center for 54 months. The blood glucose and lipids and blood pressure as well as medical cost in two groups were evaluated after 18 months＇, 36 months＇ and 54 months＇ treatment. Results After 18 months＇ treatment, the target arrival rates of HbAlc, TC and LDL-C in the intensified group （55.8%, 68. 8% and 74. 2% respectively） were significantly higher than in conventional group （29.9%, 56.5% and 54. 0%, all P〈0. 05）. After 36 and 54 months＇ treatment, the target arrival rate of HbAlc 6.5% （73.1% vs 24. 3% and 80. 3% vs 24. 6%,all P〈0. 05） was significantly higher in the intensified group than in conventional group. Blood pressure, fasting blood-glucose, HbA1c, cholesterol, HDL-C, and monthly medical cost were all different significantly among baseline, 18, 36 and 54 months＇ treatment （all P〈0. 05）. The target arrival rates of blood pressure at baseline and 18, 36 and 54 months treatment were 57. 6%, 59.3%, 60. 5% and 83.1% in the intensified group and 46.2%, 55.8%, 73.1% and 80.3% in the conventional group. The percentages of intensified group with cholesterol 〈 5.17 mmol/L were 42. 1%, 68. 8%, 63.2%, 62. 9%, respectively ,and those with HDL-C target arrival were 70. 5%,87. 5%, 81.6% and 81.4%. All of lipids profiles levels were much better in intensified group than in conventional group. In intensified versus conventional group, the overall proportion of medication was less for biguanides （56% vs 67%） and was more for sulfonylurea （70% vs 21%） and insulin （54% vs 12%）（all P〈0. 05）. The medical cost was increased by 134.5 yuan （54%） and 70. 5 Yuan RMB （30%） monthly per person in the intensified group and in conventional group respectively. Conclusion The intensified community-based treatment shows a better therapeutic effect in controlling hyperglycemia, hypertension and dyslipidemia than the conventional treatment, but with slightly increased monthly medical cost.