“5+1”分阶段糖尿病管理模式效果评价及影响因素分析

Effect Evaluation of “5+1” Staged Diabetes Target Management Mode on Patients With Type 2 Diabetes and Influencing Factors Analysis

目的:评估"5+1"分阶段糖尿病管理模式(SDTM)对2型糖尿病的社区管理效果及影响因素。方法:采用SDTM管理模式,对参与南京市宁海路社区卫生服务中心"糖尿病小屋"管理的361例糖尿病患者进行2年以上的随访管理,从SDTM平台导出数据,对管理对象的干预前后指标进行比较,并采用多因素Logistic分析血糖控制效果的影响因素。结果:管理前后,患者的血压、空腹血糖、非空腹血糖、糖化血红蛋白及低密度脂蛋白指标均数及达标率差异具有统计学意义;总胆固醇指标均数也有显著差异(P<0.05)。回归分析结果显示,糖尿病家族史(OR=2.36,95%CI=1.37~4.07)、高密度脂蛋白未达标(OR=1.66,95%CI=1.04~2.66)是血糖控制不达标的危险因素。结论:"5+1"分阶段糖尿病管理模式能够有效地改善糖尿病患者的血糖、血压、血脂控制情况。糖尿病家族史、高密度脂蛋白是影响糖尿病患者血糖控制效果的独立因素。

Objects:To assess the effect of community '5+1' staged diabetes target management mode on patients with type 2 diabetes and its influencing factors. Methods:SDTM management was conducted on 361 type 2 diabetic patients who were followed up for 2 years in Ninghailu community Self-service Health Room of Nanjing,derived datas from platform SDTM,made a comparison of intervention index of managed objects,and analyzed the influence factors of blood glucose control effect by the multi-factor Logistic. Results:Prior to the intervention, blood pressure、FPG、non-fasting blood glucose、HbA1c、TC、TG and LDL-C had statistical significance, and the index mean of total cholesterol was significant different(P < 0.05). The logistic regression analysis showed that the diabets family history、HDL-C are risk factors(OR=2.36,95%CI=1.37~4.07;OR=1.66,95%CI=1.04~2.66).Conclusion:The '5+1' Staged Diabetes Target Management Mode can effectively improve the control effect of diabetes in levels of blood glucose、blood pressure and blood lipid.The diabets family history and HDL-C are influencing factors for this effect.