基于多学科糖尿病护理团队的“互联网+”远程管理模式构建及其在妊娠糖尿病患者管理中的应用

Construction of“Internet Plus”remote management mode based on multidisciplinary diabetes care team and its application in management of gestational diabetes mellitus patients

目的:探讨基于多学科糖尿病护理团队(multidisciplinar y diabetes care team,MDCT)的“互联网+”远程管理模式对妊娠糖尿病(gestational diabetes mel litus,GDM)患者治疗依从性、血糖控制情况、生活质量及妊娠结局的影响。方法:选取2019年1月至2020年12月就诊的140例GDM患者为研究对象,随机分成对照组和研究组,每组70例。构建基于MDCT的“互联网+”远程管理模式。对照组采用MDCT管理模式进行管理,研究组在对照组MDCT管理方案的基础上采用基于“互联网+”的个体化远程管理。干预前及分娩前1周,应用糖尿病治疗依从性量表评估两组患者的治疗依从性,监测两组患者的血糖水平并计算血糖达标率,采用36项健康调查简表(Short-Form 36-item,SF-36)评估两组患者的生活质量,随后比较两组上述指标干预前后的变化情况及组间差异。妊娠结束后,比较两组的妊娠结局以及患者对干预方法的满意度。结果:截至研究结束时两组各失访7例。两组患者干预后药物、饮食、运动、自我监测、定期复查5个维度的治疗依从性得分及总得分均显著高于干预前(P<0.05或P<0.001),且研究组的改善程度均显著高于对照组(P<0.05或P<0.001);研究组治疗依从性较好率为90.48%,显著高于对照组(42.86%),差异有统计学意义(P<0.001)。两组患者干预后的空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h postprandial blood glucose,2hPBG)以及糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平均显著改善(均P<0.001),且研究组的改善程度均显著优于对照组(P<0.05或P<0.001);对照组干预后血糖达标率为9.52%,显著高于对照组,差异有统计学意义(P=0.036)。对照组干预后在总体健康、精神健康方面的评分均显著降低(均P<0.05),但研究组的上述评分均较干预前显著升高且高于对照组(均P<0.05);两组干预后活力、社会功能方面的评分均显著降低(均P<0.001),但研究组的降低程度均显著低于对照组(P<0.05或P<0.001)。研究组患者羊水过多、新生儿低血糖、胎儿生长受限发生率均显著低于对照组(均P<0.05);但胎膜早破、早产、巨大儿及新生儿呼吸窘迫发生率与对照组比较差异无统计学意义(P>0.05)。针对所接受的干预方法,研究组患者满意度显著高于对照组(P<0.05)。结论:对GDM患者采用基于MDCT的“互联网+”远程管理模式进行管理,可提高患者的治疗依从性、改善血糖控制水平及生活质量,同时可降低母婴并发症发生率,效果满意、值得推广。

Objective:To explore the effect of“Internet Plus”remote management mode based on multidisciplinary diabetes care team(MDCT)on treatment compliance,blood glucose control,quality of life and pregnancy outcome in gestational diabetes mellitus(GDM)patients.Methods:A total of 140 patients with GDM from January 2019 to December 2020 were selected as the research object and were randomly divided into control group and study group,with 70 cases in each group.The“Internet Plus”remote management mode based on MDCT was built.The control group was managed by MDCT management mode,while based on MDCT management mode of the control group,the research group adopted the“Internet Plus”based on individual remote management mode.Before intervention and one week before delivery,the compliance of the two groups was assessed by the compliance scale of diabetes treatment,the blood glucose levels were monitored between the two groups and the blood glucose compliance rate was calculated,the quality of life of the 2 groups were assessed by the Short-Form 36-item(SF-36)health survey,and then the changes and differences of the above indicators between the two groups before and after the intervention were compared.After pregnancy,the pregnancy outcomes of the 2 groups and the patients’satisfaction with the intervention methods were compared.Results:By the end of the study,7 cases in each group had been lost to follow-up.After the intervention,the treatment compliance scores in the five dimensions of medication,diet,exercise,self-monitoring,and regular review and the total scores in the 2 groups were significantly higher than those before the intervention(P<0.05 or P<0.001),and the improvement degrees in the study group were significantly higher than those in the control group(P<0.05 or P<0.001).The good treatment compliance rate of the study group was 90.48%,which was significantly higher than that of the control group(42.86%)(P<0.001).The levels of fasting blood glucose(FBG),2 h postprandial blood glucose(2hPBG)and glycosylated hemoglobin(HbA1c)level in the 2 groups were significantly improved after intervention(all P<0.001),and the improvement degrees of the study group were significantly better than those of the control group(P<0.05 or P<0.001).After the intervention,the compliance rate of blood glucose in the control group was 9.52%,which was significantly higher than that in the control group(P=0.036).After the intervention,the scores of overall health and mental health in the control group decreased significantly(all P<0.05),but the above scores in the study group were significantly higher than those before the intervention and higher than those in the control group(all P<0.05);the scores of vitality and social function in the 2 groups decreased significantly after intervention(all P<0.001),but the degrees of reduction in the study group were significantly lower than those in the control group(P<0.05 or P<0.001).The incidence of polyhydramnios,neonatal hypoglycemia and fetal growth restriction in the study group were significantly lower than those in the control group(all P<0.05).However,there were no significant differences in the incidence of premature rupture of membranes,preterm delivery,macrosomia,and neonatal respiratory distress between the 2 groups(all P>0.05).According to the intervention methods,the patients’satisfaction score in the study group was significantly higher than that in the control group(P<0.05).Conclusion:The“Internet Plus”remote management mode based on MDCT for GDM patients can improve the treatment compliance,the blood glucose control level,and quality of life,and reduce the incidence of maternal and infant complications,so it has satisfactory effect and is worthy of promotion.