糖尿病合并慢性并发症患者社区规范化管理意义研究

Significance of community standardized management in patients with diabetes mellitus complicated with chronic complications

目的糖尿病慢性并发症的防治离不开早期干预,如何规范管理糖尿病患者,减少和延缓糖尿病并发症的发生和发展,已成为目前全科医生的工作重点。本研究探讨社区糖尿病规范化管理对糖尿病合并慢性并发症患者的血糖水平和慢性并发症发展情况的影响,为社区糖尿病的规范化管理提供参考。方法选取2016-10-15-2017-11-30于东城区十字坡社区卫生站就诊的130例糖尿病合并慢性并发症患者作为研究对象,按照管理方式的不同分为规范化管理组和对照组,各65例。规范化管理组制定特异的饮食和运动方案,实施血糖自我监测、个性化健康宣教及规范药物治疗,并将监测结果记录在糖尿病规范化管理手册上,对照组进行规范的药物治疗和定期随访。在第3和第6个月监测两组空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2-hours plasma glucose,2hPG)和糖化血红蛋白(glycosylated hemoglobin,HbA1C)水平。在第6个月糖尿病合并慢性肾病患者行尿微量白蛋白/肌酐(albumin-creatinine ratio,ACR)监测,糖尿病合并周围神经病变患者行10g尼龙丝检查。结果干预3个月后规范化管理组和对照组2hPG水平分别为(9.53±1.32)和(10.04±1.51)mmol/L,差异有统计学意义,t=2.058,P=0.042,6个月后规范化管理组FPG水平为(7.13±0.95)mmol/L,低于对照组的(7.59±0.99)mmol/L,t=2.740,P=0.007;2hPG水平为(8.79±0.98)mmol/L,低于对照组的(9.40±1.26)mmol/L,t=3.063,P=0.003;HbA1C水平为(7.32±0.85)%,低于对照组的(8.14±0.93)%,t=5.260,P<0.001。两组FPG、2hPG和HbA1C水平伴随时间推移均发生变化,且干预方法和时间交互作用显著,均P<0.05。6个月后糖尿病肾病患者行ACR监测,规范化管理组阳性率为25.81%,对照组为54.84%,差异有统计学意义,χ~2=5.429,P=0.037。糖尿病合并周围神经病变患者行10g尼龙丝试验规范化管理组阳性率为23.53%,对照组为52.94%,差异有统计学意义,χ~2=6.227,P=0.024。结论实行糖尿病规范化管理后,糖尿病合并慢性并发症患者的血糖水平控制更好,对控制慢性并发症的发展有积极作用。

OBJECTIVE The prevention and treatment of chronic complications of diabetes can not be separated from early intervention.How to standardize the management of diabetic patients,reduce and delay the occurrence and development of diabetic complications,has become the focus of general practitioners.This study aims to explore investigate the effect of standardized management of diabetes mellitus on blood glucose levels and chronic complications in patients with diabetes mellitus complicated with chronic complications,and to provide reference for standardized diabetes management in community.METHODS A total of 130 patients with diabetes mellitus complicated with chronic complications were enrolled in the cross slope community health station of Dongcheng District from October 15,2016 to November 30,2017.The standardized management group formulated a specific diet,exercise program,blood sugar self-monitoring,personalized health education,standardized drug treatment.Their monitoring results were recorded in the standardized management manual of diabetes.The control group had standardized drug treatment and regular follow-up.The fasting plasma glucose(FPG),postprandial 2-hour plasma glucose(2-hour PG)and glycosylated hemoglobin(HbA1 C)levels were monitored at third and sixth months.At the sixth month,urinary albumin-creatinine ratio(ACR)was monitored in patients with diabetes mellitus and chronic kidney disease,and 10 g nylon wire test was performed in patients with diabetes mellitus and peripheral neuropathy.RESULTS After 3 months,2 hPG level of standardized management group was(9.53±1.32)mmol/L,significantly lower than control group(10.04±1.51)mmol/L,t=2.058,P=0.042.After 6 months,FPG,2 hPG and HbA1 clevel of standardized management group were significantly lower than those of control group[(7.59±0.99,7.13±0.95;t=2.740,P=0.007),(9.40±1.26,8.79±0.98;t=3.063,P=0.003),(8.14±0.93,7.32±0.85;t=5.260,P<0.001)].Levels of FPG,2 hPG and HbA1 cin both groups changed with time,and the intervention method and time interaction were significant(all P<0.05).After 6 months,the positive rate of ACR test in standardized management group was significant lower than that of the control group(54.84%,25.81%;χ~2=5.429,P=0.037).The positive rate of 10 g nylon yarn test in standardized management group was significant lower than that in the control group(52.94%,23.53%;χ~2=6.227,P=0.024).CONCLUSION After the implementation of standardized management of diabetes,blood glucose levels in patients with diabetes complicated with chronic complications are better controlled and have positive effect on the control of chronic complications.