基于分级诊疗制度的2型糖尿病患者县区一体全过程管理模式初探

Preliminary study on the county-district integrated wholeprocess management mode for patients with type 2 diabetes mellitus based on the hierarchical medical system

目的探讨基于分级诊疗制度的2型糖尿病患者县区一体全过程管理模式。方法选取2017-06至2018-06秦山街道社区中心医院所属3个社区的150位2型糖尿病患者作为对照组,选取同期西塘桥社区中心医院所属3个社区的150位2型糖尿病患者作为研究组,对照组给予传统模式进行糖尿病管理,研究组在对照组的基础上给予县区一体全过程管理模式进行糖尿病管理,比较管理前后两组血糖指标[空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2-hour plasma glucose,2 h PG)、糖化血红蛋白(hemoglobin A1C,HbA1C)]水平、血脂指标[总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)]水平和血压水平、管理期间并发症及转诊率、糖尿病知识问卷得分及依从性。结果管理6个月、18个月后研究组FPG、餐后2 h PG、HbA1C、TC、TG、LDL-C及HDL-C水平均明显优于对照组,差异均有统计学意义(P<0.05);研究组并发症发生率及转诊率均明显低于对照组,糖尿病问卷及依从性评分均明显高于对照组,差异均有统计学意义(P<0.05)。结论在分级诊疗制度下,为2型糖尿病患者实施县区一体全过程管理模式可以更好地控制血糖水平,改善血脂水平,提高患者的依从性,降低并发症发生率。

Objective To explore the county-district integrated wholeprocess management mode for patients with type 2 diabetes mellitus based on the hierarchical medical system.Methods 150 patients with type 2 diabetes mellitus in 3 communities affiliated to Qinshan street community central hospital from June 2017 to June 2018,were selected as the control group,while 150 patients with type 2 diabetes mellitus in 3 communities affiliated to Xitangqiao community central hospital in the same period were selected as the study group.The control group was given the traditional diabetes management mode,while the study group was given the county-district integrated wholeprocess management mode based on that of the control group.Then,the levels of blood glucose indicators [fasting plasma glucose (FPG),2-hour plasma glucose (2h PG),hemoglobin A1C (HbA1C)],blood lipid indicators [total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C)] and blood pressure before and after the management,complications and referral rates during the management,diabetes knowledge questionnaire score and compliance were compared between the two groups.Results 6 months and 18 months after the management,the levels of FPG,postprandial 2 h PG,HbA1C,TC,TG,LDL-C,and HDL-C in the study group were significantly better than those in the control group,and the differences were statistically significant (P<0.05).The incidence of complications and referral rate in the study group were significantly lower than those in the control group;the diabetes knowledge questionnaire scoreand compliance were significantly higher than those in the control group;and the differences were statistically significant (P<0.05).Conclusions Under the hierarchical medical system,the implementation of the county-district integrated wholeprocess management mode for the patients with type 2 diabetes mellitus can better control the blood glucose levels,improve the blood lipid levels,improve the patients’ compliance,and reduce the incidence of complications.