1型糖尿病患者整合医疗管理实施效果分析

Effect of integrated medical management in patients with type 1 diabetes mellitus

目的分析整合医疗管理对1型糖尿病(T1DM)患者的管理效果。方法纳入符合标准的T1DM患者287例,对其实施为期3年的整合医疗管理,通过政府专项资金,建立治疗中心,为患者提供干预治疗及门诊规范化的慢性病管理。干预治疗包括提供胰岛素治疗、注射用针头、血糖自我监测(SMBG)器械、定期糖尿病教育及监测各项观察指标。对比管理前、管理3年后的观察指标,评估管理效果。结果与管理前比较,管理后儿童青少年、成人和老年T1DM患者SMBG频率、胰岛素强化治疗率均升高(均P<0.01),酮症发生率和住院频次均下降(均P<0.05),且儿童青少年T1DM患者每日胰岛素剂量升高(P<0.01)。与管理前比较,管理后儿童青少年、成人T1DM患者餐后2 h C肽水平、HbA1c达标率和运动达标率均下降(P<0.05),且成人T1DM患者饮食控制率升高(P<0.01)。结论整合医疗管理实施有利于提高T1DM患者的自我管理意识和技巧,减少并发症的发生,减轻疾病负担;但尚需引导患者适当开展运动治疗和控制饮食,以提高管理效果。

Objective To analyze the effect of integrated medical management on patients with type 1diabetes mellitus(T1DM).Methods A total of287 T1DM patients were enrolled in this study,and integrated medical management was implemented for them for three years.Through special government funds,a treatment center was established to provide patients with therapeutic intervention and standardized chronic disease management in the outpatient department.Interventions included insulin therapy,injection needles,blood glucose self-monitoring(SMBG)devices,regular diabetes education,and observation indicator monitoring.The management effect was evaluated by comparing the observation indicators before and after the management for three years.Results SMBG frequency and intensive insulin therapy rate of T1DM patients in children and adolescents,adults and the elderly increased after the management(all P<0.01),but the ketosis incidence and hospitalization frequency decreased(all P<0.05),and daily insulin dose of T1DM patients in children and adolescents increased(P<0.01).Compared with those before the management,the 2 h postprandial c-peptide level,HbA1c compliance rate and exercise compliance rate of T1DM patients in children and adolescents and adults decreased(all P<0.05),and dietary control rate of adult T1DM patients increased(P<0.01).Conclusion Integrated medical management is effective for improving self-management awareness and skills of T1DM patients,reducing the occurrence of complications and medical cost.However,it is still necessary for patients to have exercise and diet control to strengthen the management effect.