2型糖尿病患者胰岛素治疗结构化管理模式研究

Study on structured management mode of insulin therapy in patients with type 2 diabetes mellitus

目的观察和评估使用预混胰岛素治疗的2型糖尿病患者接受结构化管理模式干预后的临床疗效变化。方法选取48例口服降糖药物但血糖控制不佳的2型糖尿病患者,随机分为结构化管理模式干预组和对照组,随访16周,两组患者均接受2次/d的预混胰岛素治疗。结构化管理模式干预组共接受9次访视,由教育护士进行强化教育与管理,鼓励患者有问题主动咨询医护人员;对照组共接受6次访视,由教育护士按照各个医院日常行为规范对患者进行教育。观察糖化血红蛋白(HbA1c)、空腹C-肽(C-P)、7点血糖谱和行为认知改变等有效性指标及低血糖、不良事件和肝肾功能等安全性指标。结果两组治疗后,HbA1c、7点血糖谱均较前明显降低(P<0.01),且结构化管理模式干预组较对照组下降更为显著(P<0.01或P<0.05)、行为和认知改变更明显;体质量指数(bodymass index,BMI)和空腹C-P无显著差异(P>0.05),结构化管理模式干预组低血糖的发生率更低(P<0.05)。结论使用预混胰岛素治疗的2型糖尿病患者,接受结构化管理模式干预后血糖整体控制情况更佳,有更好的行为和认知改变,低血糖的发生风险更低。

Objective To observe and evaluate the clinical effect of structured management mode of premixed insulin therapy in patients with type 2 diabetes. Methods In this study, 48 patients with type 2 diabetes were randomly as- signed to two groups. They received premixed insulin subcutaneously twice a day and then were followed up for 16 weeks. Patients in the structured management intervention group received 9 times supervision and intensive education and management by specialized education nurse. While patients in the control group only received 6 times generally su- pervision and education. All patients were required to receive laboratory examination before and after the treatment, in- cluding HbA1 c, fasting C-peptide, 7-time points blood sugar spectrum, et al and fill in related questionnaire. Adverse reactions were also observed. Results The levels of HbAlc and 7-time points blood sugar spectrum decreased in both groups, while were much lower in the structured management intervention group（ P 〈 0.01 or P 〈 0.05 ）. Behavior and cognitive significantly improved in the structured management intervention group compared to the control group. There were no significant differences of BMI and fasting C-peptide before and after treatment, also between two groups. Low- er incidence of hypoglycemia was reported in the structured management intervention group（P 〈 0.05 ）. Conclusion After the structured management intervention treatment, type 2 diabetes mellitus patients using the premixed insulin ther- apy have a better blood sugar control, a better behavior and cognitive change, and a lower risk of hypoglycemia.