家庭医生服务模式下延续性照护在2型糖尿病患者中的应用

Effects of continuous care on patients with type 2 diabetes mellitus under general practitioner services

目的探讨家庭医生服务模式下的延续性照护在2型糖尿病(T2DM)患者中的应用效果。方法采用便利抽样法,选取2018年6—12月与河南省新乡市中心医院合作的4所社区医院内签约家庭医生服务制的T2DM患者116例为家庭医生组,给予家庭医生服务模式下的延续性照护,包括签约式服务、个性化诊疗方案、加强患者自我管理水平、家庭干预等。另选取同期于社区医院进行延续性护理的T2DM患者100例为常规随访组,给予常规的社区延续性照护。干预6个月后,两组患者住院复查,比较两组血糖相关指标,统计低血糖发生率;比较两组血糖变异性。结果干预6个月后,家庭医生组患者BMI(23.04±2.06)kg/m2、空腹血糖(6.98±1.40)mmol/L、餐后2 h血糖(7.71±1.57)mmol/L、糖化血红蛋白(7.00±1.43)%,均低于常规随访组,差异有统计学意义(t值分别为-2.376、-5.547、-7.392、-5.295;P<0.05);48 h动态血糖监测显示,家庭医生组患者血糖变异系数(16.21±5.77),常规随访组(25.48±6.56),差异有统计学意义(t=-11.049,P<0.01)。干预期间,家庭医生组患者低血糖发生率为10.34%,常规随访组为32.00%,差异有统计学意义(χ^2=14.049,P<0.01)。结论家庭医生服务模式下的延续性照护可以更有效的改善T2DM患者的血糖控制状况,提高血糖控制的稳定性,减少血糖波动。

Objective To explore the effects of continuous care on patients with type 2 diabetes mellitus(T2DM)under general practitioner services.Methods Totally 116 T2DM patients who have signed to receive general practitioner services from June to December 2018 were selected from 4 community hospitals which cooperated with Xinxiang Central Hospital by convenient sampling,who received continuous care under general practitioner services,including signing ceremony service,personalized diagnosis and treatment protocol,enhancing patients'self-management abilities and family intervention.Another 100 T2DM patients received continuous care in community hospitals during the same period were selected as the conventional follow-up group,who received conventional continuous care in the community.Patients in both groups were re-examined in the hospital 6 months after intervention.Indexes related to blood glucose were compared between the two groups,and the incidence rate of hypoglycemia was calculated.The variability of blood glucose was compared between the two groups.Results Six months after intervention,the body mass index(BMI)was(23.04±2.06)kg/m2;the fasting blood glucose(FBG)was(6.98±1.40)mmol/L;the 2-hours postprandial blood glucose was(7.71±1.57)mmol/L;and the glycosylated hemoglobin was(7.00±1.43)%in the general practitioner service group,which were lower than those in the conventional follow-up group,and the differences were statistically significant between the two groups(t=-2.376,-5.547,-7.932,-5.295;P<0.05).48 h dynamic blood glucose monitoring revealed that the variable coefficient of blood glucose was(16.21±5.77)in the general practitioner service group and(25.48±6.56)in the conventional follow-up group,and there was statistically significant difference between the two groups(t=-11.049,P<0.01).During the intervention,the incidence rate of hypoglycemia was 10.34%in the general practitioner service group and 32.00%in the conventional follow-up group,and there was statistically significant difference between the two groups(χ^2=14.049,P<0.01).Conclusions Continuous care under general practitioner services can effectively enhance glycemic control in T2DM patients,improve the stability of glycemic control,and reduce glycemic volatility.