上海市部分社区老年糖尿病患者血糖达标现状及医院—社区—家庭标准化管理模式干预效果

Investigation on the Current Status of Blood Glucose in Elderly Diabetic Patients in the Community and the Intervention Effect of Hospital-Community-Family Standardized Management Mode of Shanghai

目的:调查上海市部分社区老年糖尿病患者血糖达标现状,并分析医院—社区—家庭标准化管理模式对未达标患者的干预效果。方法:2020年1月—2021年12月,选取上海市浦东新区高行、高东、高桥3个社区已经确诊的老年2型糖尿病患者108例作为研究对象。调查患者的血糖达标状况,采用多因素logistic回归分析模型分析血糖达标的影响因素。对42例血糖未达标患者采用医院—社区—家庭标准化管理干预模式进行干预,分析干预前、干预3个月后的效果。结果:社区老年糖尿病患者的血糖达标率为61.11%。多因素logistic回归分析结果显示,病程<10年、饮食控制良好、按计划运动、无微血管病变、服药依从性好、大专及以上文化程度、家庭收入>6 000元、胰岛素抵抗指数≤2.95是影响社区老年糖尿病患者血糖达标的因素。对血糖未达标的42例患者进行干预后,患者空腹血糖、餐后2 h血糖、糖化血红蛋白水平明显低于干预前,其中有13例患者血糖达标。结论:社区老年糖尿病患者血糖达标的影响因素多为客观原因,实施医院—社区—家庭标准化管理模式可以有效改善患者的不良饮食和行为习惯,从而促进社区老年糖尿病患者血糖达标率的提高。

OBJECTIVE To investigate the current status of blood glucose compliance of elderly diabetic patients in the communi-ty and to analyze the intervention fect of the hospital--community-family standardized management model of Shanghai.METHODS From January 2020 tp December 2021,108 elderly patients with type 2 diabetes who had been diagnosed in Gaoxing,Gaodong and Gaoqiao communities in Pudong New Area,Shanghai were selected to investigate the blood glucose status,and the multivariate logis-tic regression analysis model was used to analyze the influencing factors of blood glucose standards.The intervention model was used in 42 patients with substandard blood glucose,and the effects before and after 3 months of intervention were analyzed.RESULTS The blood glucose compliance rate of the elderly diabetic patients in the community was 61.11%.The results of multivariate logistic regression analysis showed that disease duration<10 years,good diet control,exercise as planned,no microvascular opathy,good medication compliance,college education or above education,family income>6000 yuan,and insulin resistance index≤2.95 were the factors that affected the blood glucose standard of elderly patients in the community.After the intervention of 42 patients who failed to meet the standard,their fasting blood glucose,2 hours postprandial blood glucose and glyca 1 c levels were significantly lower than before the intervention,and 13 patients reached the standard.CONCLUSION Most of the influencing factors for reaching the blood glucose standard of elderly patients in the community are objective reasons.The implementation of hospital-communi-ty-family standardized management mode can effectively improve the patients’bad diet and behavior habits,so as to promote the improvement of reaching the blood glucose standard rate of elderly diabetic patients in the community.