社区多元化糖尿病综合管理方式的建立与疗效分析

目的优化社区多元化糖尿病综合管理方式,研究健康教育对糖尿病社区管理的作用.方法随机选取在2015年4月到2015年6月在上海市闵行区梅陇社区卫生服务中心接受治疗的糖尿病患者100例,将其分为两组,即常规管理组以及糖尿病健康促进小组.其中,全科医生（GP）对于常规管理组的患者实施常规的管理方式,对于糖尿病健康促进小组的患者实施健康宣教的多元化的综合管理,干预的时间是1年.在干预前后,分别对两组患者进行系统地糖尿病病情的评估、糖尿病患者知识、自我管理技能、糖尿病生活质量,患者对GP职责的认识情况进行相应的问卷调查以及对GP满意率实施测评.比较两组方式的疗效.结果两组在干预后都比干预前的知识、自我管理水平以及生活质量有显著提高（P〈0.05）.在干预前,两组的上述指标都没有显著差异（P〉0.05）,干预后,健康促进组的上述指标明显优于常规管理组（P〈0.05）.健康促进组在干预后对GP的满意率明显优于常规管理组.结论通过优化社区糖尿病综合管理方式,将健康教育与促进完全与糖尿病诊疗进行整合,提高社区糖尿病的疗效与依从性,降低并发率,减少医疗支出,可在社区进行推广.

糖尿病综合管理模式对糖尿病患者血糖及并发症的影响

目的探讨糖尿病综合管理模式对糖尿病患者血糖及并发症的影响,分析糖尿病综合管理模式对糖尿病防治的意义。方法选择2016年1月—2017年6月期间在该院就诊的432例2型糖尿病患者作为研究对象,就诊时随机分为对照组和观察组,对照组共纳入220例,观察组共纳入212例。对照组患者均根据病情需要给予口服药物或皮下注射胰岛素治疗,门诊随诊,观察组划着在此基础上给予糖尿病综合管理患者给予每位患者随访至入组后12个月,观察两组患者血糖控制及并发症发生情况。结果血糖控制情况:观察组空腹血糖、餐后2 h血糖、糖化血红蛋白分别为(5.9±0.4)mmol/L、(7.6±0.6)mmol/L、(5.5±0.3)%,优于对照组的(7.2±0.4)mmol/L、(8.9±1.0)mmol/L、(6.7±0.5)%,差异有统计学意义(P<0.05);并发症情况:低血糖发生率7.1%(15例) vs 13.2%(29例),1年内新出现并发症5.7%(12例) vs12.7%(28例),差异有统计学意义(P<0.05)。结论糖尿病综合管理模式对糖尿病患者血糖控制和延缓并发症的出现具有重要意义。

建立1型糖尿病登记随访队列的可行性研究

目的探讨建立1型糖尿病登记随访队列的可行性。方法选取2016年1月~2018年6月我院收治的1型糖尿病(T1MD)患者110例,所有入选者均采用EpiInfo7软件登记随访资料,建立随访队列,进行为期2年的随访,在随访期间实施糖尿病综合管理干预。对比所有患者随访前、后糖化血红蛋白(HbA1c)水平与自我管理技能水平。结果随访结束后,110例患者HbA1c水平明显低于随访前,差异有统计学意义(P<0.05);随访结束后,110例患者自我管理技能水平明显高于随访前,差异有统计学意义(P<0.05)。结论建立T1MD登记随访队列可行性较好,可有效帮助患者控制HbA1c水平,提高自我管理技能水平,对改善疾病预后情况具有积极作用。

Endovascular management of patients with coronary artery disease and diabetic foot syndrome： A long-term follow-up

Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients. Methods We retrospectively included 220 diabetic patients （78.5 ±15.8 years, 107 females, all with Fontaine Ⅲor Ⅳclass） who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010. Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease （CAD） and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions. Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure （TcPO2） before and after the procedure were performed as well as stress-echocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly. Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography. In the rest of 126 patients, combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients. Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients. For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients （77.7%） and contralateral cross-over in 40/220 patients （18.8%） and popliteal retrograde ＋ femoral antegrade in 10/220 patients （4.5%）. Balloon angioplasty was performed in 252 legs （32 patients had bilateral disease）： the procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TcPO2 and ABI with ulcer healing in 233/252 legs （92.4%）. Freedom from major amputation was 82.8% at a mean follow-up of 3.1 ±1.8 years （range 1 to 5 years） whereas survival was 88%. Conclusions Global coronary and peripheral endovascular management of diabetic foot syndrome patients seems to lead to an high immediate success and limb salvage rates and increasing survival compared to historical series.

微创及无创血糖检测方法研究现状

血糖检测已成为我国糖尿病综合管理中最薄弱的环节,对糖尿病患者的血糖水平进行长期监测是控制糖尿病及其并发症发展的重要手段,血糖检测方法的技术革新对实现血糖精准检测有着深远意义。本文论述了微创及无创血糖检测方法包括尿糖检测法、泪液检测法、组织液外渗法以及光学检测等方法的基本原理,重点分析了微创及无创血糖检测方法的优势及最新成果,归纳总结了各类检测方法目前存在的问题并对未来发展趋势进行展望。