300例糖尿病患者社区强化管理和治疗的疗效观察

The clinical efficacy of systematic reinforcement treatment in patients with type 2 diabetes mellitus in community

目的 探索糖尿病社区强化管理和治疗的有效模式 ,提高糖尿病患者的治疗达标率 ,减少医药费。 方法 选择已经确诊的糖尿病患者 30 0例 ,按照同等病情分为强化管理和治疗组及普通治疗组。强化管理和治疗组采用量化饮食治疗、量化运动治疗、指导合理用药、健康教育和心理疏导 ,医生对患者一对一地指导等治疗方法 ;普通治疗组为药物治疗和一般性教育。观察两组连续治疗 3个月病情控制与药费情况。 结果 强化管理和治疗组患者的空腹血糖值平均为 6 .48mm ol/ L,明显低于普通治疗组的 7.6 0 mm ol/ L(P<0 .0 0 1) ;餐后血糖值平均为 8.5 9mm ol/ L,明显低于普通治疗组的 11.31m mol/ L (P<0 .0 0 1)。患者的血糖达到控制良好标准者占 48.4% ,明显高于普通组 2 0 .8% (P<0 .0 0 1)。血糖控制仍在不良状态的患者强化组为 2 6 .1% ,明显低于普通组的 47.7% (P<0 .0 0 1)。强化管理和治疗组糖化血红蛋白 (Hb A1c)平均为 (7.79± 1.13) % ,明显低于普通治疗组 9.31(± 1.85 ) % (P<0 .0 0 1)。 Hb A1c控制良好率为 5 2 .3%明显高于普通组的 18.8% (P<.0 0 1)。 BMI、腰围、血脂两组无明显差别。糖尿病患者的医药费强化管理和治疗组每人每月下降 5 9.9元 ,下降幅度为2 3.6 %。普通治疗组每人每月上涨 1.8元 。

Objective To study the effectiveness of systematic reinforcement training by quantification diet and exercise in patient with type 2 diabetes mellitus in community. Methods Patients with type 2 diabetes were randomized to undergo two groups: the group with systematic reinforcement treatment (education, quantification diet, exercise treatment and oral drugs) and the group without systematic reinforcement treatment (oral hypoglycemic drugs). Participants ( n =300) were followed for 3 months, during which fasting glucose,2 h postprandial glucose, HbA 1c TC, TG, and HDL C were determined at regular intervals to evaluate treatment effects. Results The average values of fasting and 2 h glucose were 6.48 mmol/L and 8.59 mmol/L resectively in the group with systematic treatment, and 7.60 mmol/L and 11.3 mmol/L respectively in the group without systematic treatment. There was significant difference between the two group ( P <0.001). The ratio of patients with optimal control of blood sugar was 48.4% in group with systematic treatment, and 20.8% ( P <0.001) in the group without systematic treatment. HbA 1c was evidently lower in group with systematic treatment than in group without systematic treatment. The ratio of patients with optimal control of HbA 1c was 52.3% in the group with systematic treatment, and 18.8% ( P <0.001) in the group without systematic treatment. TC was (4.86±0 86) mmol/L in the group with systematic treatment, which was lower than that in group without systematic treatment (5.30±0 91) mmol/L, ( P <0.05). HDL C was 1.43±0 44 mmol/L in the group with systematic treatment, which was higher than that in group without systematic treatment (1.12±0.55 mmol/L ( P <0.05). The cost of medicine was decreased in the group with systematic treatment. Everyone's medicine cost decreased by 59.9 yuan per month (decreased 23.6%). It was high in the group without systematic treatment with everyone's medicine cost risen by 1.8 yuan per month (rise by 0.7%). Conclusion The curative efficacy in the group with systematic treatment was 2～3 times higher than in group without systematc treatment , and the cost of medicine was lessened when systematic treatment was adopted in patients with type 2 diabetes in community.