糖尿病合并高血压患者社区管理三年效果观察

Effect of community management of diabetic patients with hypertension

目的探讨社区糖尿病规范化管理3年对提升糖尿病合并高血压患者联合达标率的管理效果。方法收集2008年7月崔各庄社区参加北京社区糖尿病管理研究资料完整的376例2型糖尿病患者的资料，其中196例为单纯糖尿病者（单纯糖尿病组）、180例为糖尿病合并高血压者（糖尿病合并高血压），两组基线年龄、性别构成、糖尿病病程、文化程度、人均月收入、脑卒中史差异均无统计学意义；糖尿病合并高血压组有血脂异常史者占41．7％（75／180），高于单纯糖尿病组的24．5％（48／196）（x2=11．938，P=0．001）。采取以药物治疗为基础结合健康教育、强化生活方式等干预行纵向管理3年，比较分析管理前后两组的临床指标及血糖、血压、血脂单项达标率及联合达标率。结果①两组管理前后应用降糖药物种类[单纯糖尿病组（1．31±0．93）比（1．32±0．81）种，糖尿病合并高血压组（1．48±0．82）比（1．43±0．72）种]差异均无统计学意义（t=-0．155，P=0．877；t=0．831，P=0．407），管理后糖尿病合并高血压组应用降压药物种类下降[（1．25±0．45）比（1．12±0．77）种，t=2．484，P=0．014]，糖尿病组他汀应用率明显提高[13．3％（26／196）比5．1％（10／196），x2=7．830，P=0．005]。②管理后，糖化血红蛋白（HbAIc）较管理前单纯糖尿病组下降明显[（7．4±1．5）比（7．8±2．1）％]，差异有统计学意义（t=2．586，P=0．011），糖尿病合并高血压组下降差异无统计学意义[（7．2±1．4）比（7．4±1．8）％，t=1．452，P=0．148]；糖尿病合并高血压组的收缩压[（129±-12）比（133±16）mmHg（1mmHg=0．133kPa）]和舒张压[（80±8）比（82±10）mmHg]均明显下降，差异有统计学意义（t=3．503，P=0．001；t=2．436，P=0．016），两组的LDL—C[单纯糖尿病组（3．0±0．9）比（3．2±1．0）mmol／L，糖尿病合并高血压组（2．9±1．0）比（3．2±1．1）mmol／L]明显下降，差异有统计学意义（t=2．165，P=0．032；t=3．210，P=0．002）。③管理后两组的血糖、血压、血脂联合达标率有提高，单纯糖尿病组为9．7％（19／196）比6．1％（12／196）（x2=1．716，P=0．190），糖尿病合并高血压组为13．9％（25／180）比5．o％（9／180），差异有统计学意义（x2=8．315，P=0．004）。④两组管理后生活方式明显改变，治疗依从性有提高。结论三级医院与社区卫生服务中心联合开展糖尿病规范化管理3年明显提高了糖尿病合并高血压患者的血糖、血压、血脂联合达标率。

Objective To evaluate the effect of community management of diabetic patients with hypertension in Beijiug Cuigezhuang community in last three years. Methods A community diabetic management program was started from 2007 in Beijing Cuigezhuang community. Three hundred and seventy six patients who participated in the program for more than 3 years were enrolled in the study, including 196 with type 2 diabetes mellitus （T2DM） only （DM group） and 180 with T2DM and hypertension （DMH）.The control rate of blood glucose, blood pressure, lipids and the comprehensive control rate were compared between two groups after 3-year intervention. Results There were no significant differences in age, gender ratio, course of diabetes, education background, monthly income and the history of stoke between two groups; while prevalence of dyslipidemia in DMH group was significantly higher than that in DM group [41.7% （75/180） vs. 24.5% （48 196）, x2=11. 938 ,P =0.001 ]. Compared with the baseline data, the types of autidiabetic drugs used were not significantly changed in two groups after 3-year intervention （ DM group： 1.32±0. 81 vs. 1.31 ±0. 93, t = -0. 155, P = 0. 877, DMH group： 1.43 ±0. 72 vs. 1.48 ±0. 82, t =0.831, P = 0. 407 ）. The types of antihypertensive drug in DMH group were significantly decrease. （1.12 ±0.77 vs. 1.25 ±0.45, t =2.484, P =0.014）, while the rate of statins usage in DM group was significantly increased [ 13.3% （26/196） vs. 5.1% （10/196）, x2 =7. 830, P =0. 005]. The hemoglobin Alc （HbAlc） levels in DM group was decreased [（7.4±1.5）% vs. （7.8 ± 2.1）%, t=2.586, P= 0.011]. The systolic pressure [（129±12） mmHg （1 mmHg=0.133 kPa） vs. （133±16） mmHg, t= 3. 503, P = 0. 001 ] and the diastolic pressure [ （ 80± 8 ） mmHg ratio （ 82± 10） mmHg, t = 2. 436, P = 0.016] in DMH group were significantly declined. The average LDL-C level DM group： （3.0 ± 0.9） mmol/Lvs. （3.2±1.0） mmol/L, t =2.165, P=0.032; DMH group （2.9 ±1.0） mmol/Lvs. （3.2 ± 1.1） mmol/L, t =3. 210, P =0. 002] were also significantly decrease. Compared with the baseline, the comprehensive control rates of blood glucose, blood pressure and lipid level were increased in both groups [ DM group：9. 7% （19/196） vs. 6. 1% （12/196） , X2 = 1. 716, P = 0. 190, DMH group 13.9% （25/180） vs. 5.0% （ 9/180 ）, X： = 8. 315, P = 0. 004 ] . Conclusions The community management program is effective for improvement of comprehensive control rates of blood glucose, blood pressure and blood lipids in diabetic patients with hypertension in Beijing Cuigezhuang community.