基于医联体分级教育干预2型糖尿病心血管疾病风险研究

Effect of medical alliance model based on graded education guidance on cardiovascular disease risk in patients with type 2 diabetes mellitus

目的:探索三级医院-紧密型医联体-家庭医生分级教育的干预新模式对2型糖尿病心血管疾病风险的影响。方法:从2014—2015年市社保中心管理离退休人群中,选取本院紧密型医联体签约的2型糖尿病(type 2 diabetes mellitus, T2DM)患者,分干预组和对照组,干预组在社区家庭医生管理基础上由专科医师及护士给予一年系统个体化生活方式干预,对照组只接受常规社区管理,社区家庭医生接受三级医院专科团队一年2次的培训。4年后,共记录数据完整的T2DM患者456例,其中女282例,男174例,平均年龄(61.82±0.35)岁,干预组168例,对照组288例,比较两组随访干预前后生化指标及心血管疾病情况。结果:(1)干预后,所有患者血糖、血脂、收缩压等较基线下降(P<0.05);(2)与对照组相比,干预组LDL-C无明显升高;(3)对照组冠心病的风险是干预组的2.53倍(P<0.05);(4)干预组的肾功能无明显下降,矫正混杂因素后,生活方式干预是肾功能下降的独立保护因素(P<0.05)。结论:基于紧密型医联体-家庭医生签约制度,三级医院专业团队介入,对2型糖尿病患者进行综合管理干预的新模式,可有效降低2型糖尿病患者心血管疾病风险。

Objective:To explore the effect of a new intervention model based on tertiary hospital-close medical union-family doctor graded education guidance on cardiovascular disease risk in patients with type 2 diabetes mellitus.Methods:From the retirees managed by the municipal social security center from 2014 to 2015,type 2 diabetes patients contracted by the hospital's close medical association were selected and divided into intervention group and control group.On the basis of community management,the intervention group was given one-year systematic individualized lifestyle intervention by specialists and nurses,while the control group only received routine community management.Community family doctors were trained twice a year by the specialized team of the tertiary hospital.A total of 456 patients with T2DM whose data were complete were finally studied,including 282 females and 174 males,with an average age of(61.82±0.35)years;among them,168 were in the intervention group and 288 in the control group.The biochemical indexes and cardiovascular disease progression were compared between the two groups before and after follow-up intervention.Results:(1)After the intervention,the blood glucose,blood lipid and blood pressure of all patients decreased significantly compared with the baseline(P<0.05);(2)There was no significant increase in LDL-C in the intervention group compared to the control group;(3)The risk of coronary heart disease in the control group was 2.53 times higher than that in the intervention group(P<0.05);(4)The renal function in the intervention group declined slowly,and after correcting the confounding factors,lifestyle intervention was an independent protective factor for the decline in renal function(P<0.05).Conclusion:The new intervention mode based on tertiary hospital-close medical union-family doctor graded education guidance can effectively reduce the risk of cardiovascular disease in patients with type 2 diabetes.