引入家庭医生式服务开展2型糖尿病管理效果初探

摘要

目的：探讨引入家庭医生式服务在社区开展2型糖尿病管理的效果。方法以99名佛山市南海区桂城平洲本地2型糖尿病患者为研究对象，均选自2012年9月~2013年3月在广州医科大学附属广佛医院内分泌科住院治疗出院、病程在1年以上患者，按照区组随机化方法抽取并分为管理组和对照组两组。由社区医生对管理组患者进行家庭医生式服务2型糖尿病随访管理，对照组患者自觉到内分泌专科门诊随访。比较两组患者差别化管理10个月后相关指标的变化。结果经过家庭医生式服务2型糖尿病随访管理，管理组患者体重指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、胆固醇(TC)、尿微量白蛋白(Malb)及尿微量白蛋白/肌酐(Malb/Cr)明显优于对照组，差异均有统计学意义(均P<0.05)；患者遵医嘱用药、饮食控制、参加锻炼和定期监测血糖的依从性明显优于对照组，差异均有统计学意义(均P<0.05)；对影响糖尿病患者血糖控制的多因素分析结果显示，高 BMI、高 TG、高 TC 是影响2型糖尿病血糖控制的危险因素，而高的血压达标率对血糖控制有促进作用(均P<0.05)。结论引入家庭医生式服务开展2型糖尿病随访管理有助于改变患者不良的生活方式，提高自我管理能力，进而提高2型糖尿病管理效果及质量。%Objective To investigate the efficacy of family doctor service in the management of patients with type 2 diabe-tes(T2DM)in the communities.Methods A total of 99 local patients with T2DM in Pingzhou Guicheng were enrolled as sub-jects in the study.All of them were hospitalized and treated in the Department of Endocrinology,Guangfo Hospital of Guang-zhou Medical University from September 2012 to March 2013 with the disease course more than one year.They were block-ran-domized into management group and control group.Patients in the management group received the family doctor service by community physicians for T2DM management.Those in the control group visited the endocrinology clinics voluntarily.The changes of related indicators were compared between the two groups 10 months later.Results The levels of BMI,FPG, HbA1c,TG,TC,Malb and Malb/Cr were significantly improved in the management group compared with the control group with the difference being significant(P<0.05).The management group was superior to the control group in terms of compli-ance to medical order,diet control,exercise and regular monitoring of blood glucose(P<0.05).Multivariate analysis showed that the high levels of BMI,TG and TC were risk factors of blood glucose control in T2DM patients.High BP compliance rate was a protective factor in the management of T2DM patients(P<0.05).Conclusion T2DM management by family doctor service helps change the unhealthy lifestyles of patients,improve self-management skills,thereby improving management effica-cy of T2DM.