全科团队创新模式对糖调节受损患者强化管理的疗效评价

Efficacy Evaluation of the Intensive Management Treatment for Patients with Impaired Glucose Regulation in a General Practice Team Innovation Model

目的评价全科团队创新模式对25~45岁糖调节受损(IGR)患者强化管理的效果。方法收集2011年以来全科团队在社区采用快速血糖仪测量空腹血糖和餐后2 h血糖时发现,并再次在我社区服务中心实验室检查空腹血糖和餐后2 h血糖确诊的IGR患者102例,按抛硬币随机分为干预组(51例)及对照组(51例),干预组予以创新模式强化管理,为期1年;对照组患者行自主的常规门诊诊治。两组均在干预前后进行血液复查及问卷调查。结果干预组患者5.9%(3/51)转为糖尿病,56.9%(29/51)的患者转为正常;对照组15.7%(8/51)转为糖尿病。19.6%(10/51)的患者转为正常,两组患者的转归差异有统计学意义(P<0.05)。干预后干预组患者空腹血糖、餐后2 h血糖和糖化血红蛋白与对照组相比差异均有统计学意义(P<0.05),糖尿病相关知识知晓率提高,差异亦有统计学意义(P<0.05)。结论采用全科团队创新模式对IGR患者进行强化管理,可降低社区IGR人群血糖,减少糖尿病发生。该模式能促进全科团队达到对IGR患者早发现、早治疗的目标。

Objective To evaluate the effect of intensive management on impaired of glucose regulation （IGR） pa- tients in 24 to 45 years old in a general practice team innovation model. Methods We recruited 102 patients from our community who were firstly found when our general practitioners measured fasting blood glucose and 2 hours postprandial blood glucose with fast - glucometer and later diagnosed as 1GR in our community service center lab. They were randomly divided into two groups, intervention group （ n = 51 ） and control group （ n = 51 ） . Intervention group was under intensive management in a general prac- tice team innovation model for one year, and control group was given routine outpatient treatment. Both of them received blood re- examination and questionnaire investigation after one year. Results The diabetes incidence of intervention group was 5.9% （3/ 51）, 56.9% （29/51） of the patients returned to normal; The diabetes incidence of control group was 15.7% （8/51）, 19. 6% （10/51） of the patients returned to normal; the differences were statistically significant （P 〈 0. 05） . After interven- tion, compared with the control group, fasting blood glucose, postprandial 2 h blood glucose and HbA^o of the intervention group were significantly different （ P 〈 0.05 ） , the known rate of knowledge of diabetes increased and the difference was statistically significant （ P 〈 0. 05 ） . Conclusion Intensive management of general practitioner （Gp） innovation model for impaired of glu- cose regulation （IGR） patients is an effective method to reduce blood glucose and the occurrence of diabetes in IGR patients. This model could help general practitioners achieve the goal for early detection, and eventually early treatment of IGR patients.