“三师共管”诊疗模式对不同病程糖尿病患者的临床疗效研究

The Effectiveness of Three Division Management for Diabetes Patients with Different Disease Courses

背景糖尿病发病率高、并发症多,已成为亟待解决的公共卫生问题,但临床防治管理水平仍不理想。目的观察“三师共管”诊疗模式对不同病程糖尿病患者代谢指标和自我管理水平的影响。方法选取2021年4月—2022年4月在广州中医药大学深圳医院(福田)内分泌科接受“三师共管”诊疗模式管理并随访6个月以上的181例2型糖尿病患者,依据病程将患者分组(A组:病程<1年;B组:病程1~5年;C组:病程>5~10年;D组:病程>10年);患者在线下门诊由中医师、内分泌专科医师、健康照护师组成的“三师”团队进行体质辨识、并发症筛查、“药、食、功、识”、中医适宜技术等综合干预;患者居家时,由健康照护师通过智能血糖仪设备和手机APP进行线上管理。在管理6个月后收集不同病程患者血糖、体质量指标的变化;并采用问卷收集患者自我管理中的常见问题,填写糖尿病自我管理行为量表6(SDSCA-6)。结果通过“三师共管”诊疗模式的管理,A组患者在干预后降低空腹血糖和餐后2 h血糖方面的疗效较好(P<0.05);A组、B组、C组、D组的BMI、腰围与干预前比较均降低(P<0.05);患者自我管理中较常见的饮食问题为饮食结构不合理(38.12%),较常见的运动问题为运动量或运动强度不足(36.46%),较常见的监测问题为监测不足(37.02%);A组、B组、C组、D组在“健康饮食”“自我监测”“医嘱依从”“教育交流”4个维度的自我管理水平与干预前比较均升高(P<0.001)。结论“三师共管”诊疗模式能够提升糖尿病患者的自我管理能力,从而改善代谢指标,起到良好的综合干预作用,临床应尤其重视对糖尿病病程<1年患者的管理。

Background Diabetes has a high incidence rate and many complications,which was an urgent public health problem,but the prevention and management is still not ideal.Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease.Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months in Shenzhen Hospital Guangzhou University of Chinese Medicine(Futian).The patients were grouped according to the course of disease(Group A:course of disease<1 year;Group B:course of disease 1-5 years;Group C:course of disease >5-10 years;Group D:course of disease>10 years);In outpatient,the three-division team composed of traditional Chinese medicine practitioners,endocrinologists and caregivers carries out comprehensive treatment such as physique identification,complication screening,medicine,food,exercises and emotion intervention;When patients are at home,the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP.We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management.Additionally,we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6(SDSCA-6).Results Through the management of the Three Division management,Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention(P<0.05).The BMI and waist circumference of groups A,B,C,and D were all reduced compared to before the intervention(P<0.05).Common dietary issues in patient self-management included an unreasonable dietary structure(38.12%),common exercise issues included insufficient exercise volume or intensity(36.46%),and common monitoring issues included insufficient monitoring(37.02%).The self-management levels of groups A,B,C,and D in the four dimensions of "healthy eating" "self-monitoring" "adherence to medical advice" and "education and communication" all improved compared to before the intervention(P<0.001).Conclusion The three division management can improve the self-management ability of diabetes patients and play a good comprehensive role in diabetes.Clinical practice should particularly emphasize the management of patients with a diabetes course of less than one year.