社区慢病管理对2型糖尿病患者的影响

Influence of Community Chronic Disease Management on Patients With Type 2 Diabetes Mellitus

目的研究2型糖尿病患者在社区慢病管理中对其健康的影响。方法选择2022年1—12月社区登记已管理2型糖尿病患者47812例,经随机数表法将入组患者分为对照组(n=23906)与观察组(n=23906),对照组实施常规管理,观察组应用社区慢病管理。评估两组患者血糖、糖化血红蛋白水平变化、心理改善程度、自我管理及随访情况。结果观察组患者管理后糖化血红蛋白、餐后2 h血糖、空腹血糖水平均低于对照组(P<0.05)。观察组患者管理后社会心理适应量表(ostomy adjustment inventory,OAI-20)中持续担忧、接受、生活态度3个维度评分均高于对照组(P<0.05)。观察组患者糖尿病管理评定量表(diabetes care profile,DCP)总评分高于对照组(P<0.05)。观察组患者最近一次随访康复血糖达标率明显高于对照组(P<0.05)。结论糖尿病患者通过社区慢病管理,血糖控制效果良好,患者自身自我管理水平得以提升,随访状况满意,这对改善患者预后极为有利,值得推广。

Objective To study the influence of type 2 diabetes patients on their health in community chronic disease management.Methods A total of 47812 patients with type 2 diabetes registered and managed in the community from January to December 2022 were selected.The enrolled patients were divided into control group(n=23906)and observation group(n=23906)by random number table.The control group was subject to routine management,and the observation group was subject to community chronic disease management.The changes of blood glucose and glycosylated hemoglobin levels,the degree of psychological improvement,selfmanagement and follow-up of the patients in the two groups were evaluated.Results The glycosylated hemoglobin,2 h postprandial blood glucose and fasting blood glucose in the observation group were lower than those in the control group on average(P<0.05).The scores of the three dimensions of continuous worry,acceptance and life attitude in the post-management psychosocial adjustment inventory(OAI-20)of patients in the observation group were higher than those in the control group(P<0.05).The total score of diabetes care profile(DCP)in the observation group was higher than that in the control group(P<0.05).The rate of reaching the standard of rehabilitation blood glucose at the last follow-up visit in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Through community chronic disease management,diabetes patients have good blood glucose control effect,their self-management level has been improved,and the follow-up situation is satisfactory,which is extremely beneficial to improve the prognosis of patients,and is worth promoting.