标准化代谢性疾病管理模式下不同体重变化的2型糖尿病患者的代谢指标转归

Body weight change and metabolic index control in patients with type 2 diabetes mellitus under standardized metabolic disease management model

目的探讨不同体重指数(BMI)2型糖尿病患者在接受标准化代谢性疾病管理(MMC)1年后,其体重变化与代谢指标转归及达标情况关系。方法将2017年11月至2021年11月接受苏州市立医院MMC管理的950例患者纳入研究,按基线BMI分为正常(BMI 18.5~23.9 kg/m^(2))、超重(BMI 24.0~27.9 kg/m^(2))和肥胖(BMI≥28 kg/m^(2))组,比较3组治疗1年后代谢指标转归及达标情况。将599例超重和肥胖患者按治疗1年后体重变化分为3组:体重减轻(<-3 kg)、体重稳定(-3~1 kg)、体重增加(>1 kg)组,比较治疗前后代谢指标及达标情况,分析超重、肥胖患者体重变化对代谢指标达标率的影响及指标变化关系。结果(1)基线时超重、肥胖组代谢指标更差,肥胖组更年轻。1年后3组代谢指标均明显改善,达标率升高;(2)1年后体重减轻组代谢指标控制更好,体重增加组控制不佳。体重减轻、维持稳定组各达标率均显著升高;(3)超重和肥胖患者体重每减少1 kg,血糖、血脂、血压及综合达标率分别增加1.206、1.046、1.069、1.107倍;体重变化与代谢指标改善呈正向线性关系。结论MMC管理模式可改善2型糖尿病患者,特别是积极减重的超重和肥胖患者的代谢指标及达标率。在今后工作中应加强对超重及肥胖患者的防治管理,增强自我管理能力,科学有效管理体重。

Objective To explore the relationship between weight change and metabolic control of type 2 diabetic patients after 1 year treatment under the standardized metabolic disease management model.Methods From November 2017 to November 2021,950 patients with T2DM in the Standardized Metabolic Management Center of Suzhou Municipal Hospital were recruited in this research,who were divided into normal(BMI 18.5-23.9 kg/m^(2)),overweight(BMI 24.0-27.9 kg/m^(2)),and obese(BMI≥28 kg/m^(2))groups according to baseline BMI.The metabolic indicators and control rates were compared.The overweight and obese 599 patients were divided into weight reduction(<-3 kg),maintenance(-3-1 kg)and gain(>1 kg)groups according to weight changes by one year,and metabolic indicators and control rates were compared to analyze the influence of weight change on metabolic control of overweight and obese patients.Results(1)The overweight and obese groups had worse metabolic control at baseline and the obese group was younger.After 1 year,the metabolic indicators of three groups were significantly improved.(2)After 1 year,the metabolic control was better in weight reduction group and worse in weight gain group.The control rates were increased in weight reduction and maintenance groups.(3)For every 1 kg reduction in body weight of overweight and obese patients,blood glucose,blood lipids,blood pressure and comprehensive control rate increased by 1.206,1.046,1.069 and 1.107 times,respectively.There was a positive linear relationship between weight reduction and metabolic improvement.Conclusion Standardized metabolic disease management model promotes metabolic control in type 2 diabetic patients,especially in overweight and obese patients who actively lose weight.In the future we should strengthen the management of overweight and obese patients,enhance self-management ability,and manage body weight scientifically and effectively.