论文部分内容阅读
目的对社区300例糖尿病患者强化管理和治疗的效果评价。方法糖尿病患者300例随机分为强化治疗组(n=145)和标准治疗组(n=155),对强化组进行强化综合干预、强化控制达标、规范随访;标准组给予常规门诊治疗管理,为期54个月。结果强化组与标准组比较,干预后18个月HbA_1c、胆固醇、LDL-C达标率显著升高(分别为55.8% vs 29.9%,68.8% vs 56.5%,74.2% vs 54.0%,P<0.05);干预后36个月和54个月,强化组较标准组HbA_1c达标率显著升高(36个月为73.1% vs24.3%,54个月为80.3%υs 24.6%,P<0.05)。强化组入组前和干预后18个月、36个月、54个月4次比较,血压、空腹血糖、HbA_1c、胆固醇、HDL-C、用药情况及月花费差异均有统计学意义(P<0.05)。血压达标率4次分别为57.6%、59.3%、60.5%、83.1%;HbA_1c为46.2%、55.8%、73.1%、80.3%;胆固醇为42.1%、68.8%、63.2%、62.9%;HDL-C为70.5%、87.5%、81.6%、81.4%。入组后18个月强化组双胍类药物所占比例较标准组少(56.1%υs 67.3%,P<0.05);磺脲类和胰岛素明显增加(分别为70.2%υs54.0%,21.3% vs 12.0%,P<0.05);降糖药月花费强化组增加134.5元,上升53.6%,标准组增加70.5元,上升29.8%。结论社区强化干预可以使血糖得到良好控制,血压、血脂较理想控制,花费略增。
Objective To evaluate the effect of intensive management and treatment of 300 diabetic patients in community. Methods Thirty patients with diabetes were randomly divided into intensive treatment group (n = 145) and standard treatment group (n = 155). Intensive and comprehensive interventions were performed to strengthen the control standard and standard follow-up. The standard group was given routine outpatient treatment and management, 54 months. Results Compared with the standard group, the compliance rates of HbA_1c, cholesterol and LDL-C in the intensive group were significantly increased at 18 months after intervention (55.8% vs 29.9%, 68.8% vs 56.5%, 74.2% vs 54.0%, P <0.05) ; 36 months and 54 months after intervention, the HbA 1c compliance rates in the intensive group were significantly higher than those in the standard group (73.1% vs 36.3% at 36 months, 80.3% vs 54.6% at 54 months, P <0.05). The levels of blood pressure, fasting blood glucose, HbA1c, cholesterol, HDL-C, medication and monthly expenditure were significantly higher in the intensive group before and 18 months, 36 months and 54 months after intervention (P < 0.05). The blood pressure compliance rate was 57.6%, 59.3%, 60.5% and 83.1% respectively four times; the HbA_1c was 46.2%, 55.8%, 73.1% and 80.3% respectively; the levels of cholesterol were 42.1%, 68.8%, 63.2% and 62.9% 70.5%, 87.5%, 81.6%, 81.4%. 18 months after enrollment, the proportion of biguanide in the intensive group was less than that in the standard group (56.1% vs 67.3%, P <0.05); sulfonylureas and insulin were significantly increased (70.2% vs 54.0%, 21.3% vs 12.0%, P <0.05). Hypoglycemic drugs increased by 134.5 yuan per month, up by 53.6%. The standard group increased by 70.5 yuan, up by 29.8%. Conclusion Intensive intervention in community can make blood sugar be well controlled, blood pressure, blood lipids more ideal control, spending slightly increased.