基于中医治未病家庭-社区-医院三级防控模式对糖尿病患者治疗效果及生活质量的影响

The Impact of the Three-Level Prevention and Control Model of Family-Community-Hospital Based on TCM Treatment on the Treatment Effect And Quality of Life Of Diabetic Patients

目的探讨基于中医治未病家庭-社区-医院三级防控模式对糖尿病患者治疗效果及生活质量的影响。方法选取2018年1月-2019年10月期间深圳市宝安区中医院内分泌科收治的151例2型糖尿病住院患者为研究对象,随机分为观察组76例和对照组75例。观察组采取家庭-社区-医院三级防控糖尿病模式,建立健康管理档案并制定健康服务计划,患者出院前接受内分泌专科医师的健康知识宣教,出院后定期接受电话/家庭医师上门随访及相应的中医干预。对照组实施常规糖尿病管理模式,出院后不定期进行随访和健康知识宣教。评价两组患者干预前后临床代谢指标及糖尿病知识水平、自我管理能力和生活质量的变化。结果干预后两组患者空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平均低于治疗前,体重指数(BMI)水平指标方面观察组患者低于治疗前(P<0.05);且观察组患者干预后BMI、FPG、2 h PG、HbA1c水平与对照组比较均明显下降(P<0.05)。干预后两组患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)水平均优于治疗前(P<0.05),且观察组血脂水平改善情况明显优于对照组(P<0.05)。干预后两组患者自我管理效能和自我管理技能评分均较治疗前升高,糖尿病知识水平评分方面观察组患者较治疗前升高(P<0.05);且观察组干预后糖尿病知识水平、自我管理效能和自我管理技能评分均显著高于对照组(P<0.05)。干预后两组患者生理维度、心理/精神维度、治疗维度评分和生活质量总分均较治疗前下降(P<0.05),且观察组干预后生理维度、心理/精神维度、治疗维度评分和生活质量总分均较对照组下降(P<0.05)。两组患者干预前后社会关系维度评分无明显变化,差异无统计学意义(P> 0.05)。结论基于中医治未病家庭-社区-医院三级防控糖尿病模式可显著改善2型糖尿病患者的临床代谢指标及加强其糖尿病知识水平和自我管理能力,对糖尿病的治疗具有积极影响,能从本质上提高患者的生活质量,值得临床推广应用。

Objective To explore the impact of the three-level prevention and control model of family-community-hospital treatment based on traditional Chinese medicine on the treatment effect and quality of life of diabetic patients.Methods From January 2018 to October 2019,151 inpatients with type 2 diabetes who were admitted to the Department of Endocrinology,Bao’an District Hospital of Traditional Chinese Medicine in Shenzhen were selected as the research objects,and were randomly divided into an observation group of 76 cases and a control group of 75 cases.The observation group adopts a family-community-hospital three-level diabetes prevention and control model,establishes health management files and develops health service plans.Patients receive health knowledge education from endocrinologists before they are discharged from the hospital,and regularly receive follow-up visits by telephone/family doctors and corresponding follow-ups after discharge.Chinese medicine intervention.The control group implemented a routine diabetes management model,followed up from time to time after discharge and health knowledge education.The changes in clinical metabolic indexes,diabetes knowledge,self-management ability and quality of life of the two groups of patients before and after intervention were evaluated.Results After the intervention,the fasting blood glucose(FPG),2 h postprandial blood glucose(2 h PG),and glycosylated hemoglobin(HbA1 c) levels of the two groups of patients were lower than before treatment,and the body mass index(BMI) level of the observation group was lower than before treatment(P <0.05);and the levels of BMI,FPG,2 h PG and HbA1 c in the observation group were significantly decreased compared with those in the control group after intervention(P <0.05).After the intervention,the levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein(LDL-C),and high-density lipoprotein(HDL-C) in the two groups were better than those before treatment(P <0.05),and The improvement of blood lipid levels in the observation group was significantly better than that in the control group(P <0.05).After the intervention,the self-management efficacy and self-management skill scores of the two groups of patients were higher than those before treatment,and the diabetes knowledge score of the observation group was higher than that before treatment(P <0.05);and the diabetes knowledge and self-management of the observation group after the intervention.The scores of efficacy and self-management skills were significantly higher than those of the control group(P <0.05).After the intervention,the scores of physiological,psychological/spiritual,therapeutic dimensionality,and quality of life of the two groups of patients decreased compared with those before treatment(P <0.05),and the physiological,psychological/spiritual,therapeutic dimensional scores and life scores of the observation group after intervention The total quality scores were all lower than those of the control group(P <0.05).There was no significant change in the social relationship dimension scores of the two groups of patients before and after intervention,and the difference was not statistically significant(P> 0.05).Conclusion The Family-Community-Hospital tertiary diabetes prevention and control model based on "Preventive Treatment of Disease" Theory of Traditional Chinese Medicine can significantly improve the clinical metabolic indexes of type 2 diabetics as well as strengthen their diabetes knowledge level and self-management ability,which has a positive impact on the diabetes treatment and can improve the quality of life of patients in essence,and that it is worthy of clinical popularization and application.