社区与三甲医院联合管理模式在社区2型糖尿病管理中的效果评价研究

摘要

目的 探讨社区与三甲医院联合管理模式在社区糖尿病纵向管理中的效果.方法 将劲松社区441例2型糖尿病患者随机分为强化管理组(强化组)220例和标准管理组(标准组)221例.强化组和标准组均由专门的全科医师在三级医院医生的指导下,按照<中国2型糖尿病防治指南(2007年版)>中的要求进行综合管理,强化组的随访、糖化血红蛋白(HbA1c)监测和尿微量清蛋白监测频次分别为1次/2个月、1次/3个月和1次/6个月,标准组分别为1次/3个月、1次/6个月和1次/年.在两组患者管理满2.5年后,对其管理效果进行评价.结果 干预前,强化组与标准组的空腹血糖(FPG)、HbA1c、收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)水平、达标率及联合达标率间差异均无统计学意义(P＞0.05),舒张压(DBP)水平间差异有统计学意义(P＜0.05);干预后,除强化组与标准组的HbA1c达标率间差异有统计学意义(P＜0.05)外,其余指标间差异均无统计学意义(P＞0.05).强化组干预前后比较,FPG、HbA1c、SBP、DBP、LDL-C水平间差异均有统计学意义(P＜0.05),FPG、HbA1c、血压达标率及联合达标率间差异均有统计学意义(P＜0.05).标准组干预前后比较,FPG、HbA1c、SBP水平间差异均有统计学意义(P＜0.05),FPG、HbA1c、血压达标率间差异均有统计学意义(P＜0.05).结论 社区卫生服务中心与三甲医院联合管理模式可以有效提高2型糖尿病患者的HbA1c达标率和联合达标率.%Objective To explore the effects of community - hospital management of type 2 diabetes mellitus ( T2DM ). Methods A total of 441 T2DM patients in Jinsong community were randomly divided into an intensive group ( 220 ) and a standard group ( 221 ) . Both groups were managed according to China Guideline for Type 2 Diabetes by general practitioners who were supervised by endocrinologists in the tertiary hospital. Follow - ups, HbA,,. test and mAlB test were conducted once every two months, every three months, and every six months in the intensive group, respectively, and once every three months, every six months, and every year in the standard group, respectively. Outcomes of the two groups were evaluated after 2. 5 years of intervention. Results Before the intervention, significant differences were not observed between the two groups in control rate and joint control rate of fasting plasma glucose ( FPG ), HbA,,., systolic blood pressure ( SBP ), and low density lipoprotein -cholesterol ( LDL - C ) ( P > 0. 05 ), but in diastolic blood pressure ( DBP ) ( P < 0. 05 ). After the intervention, significant difference was only observed in HbA1c between the two groups ( P <0. 05 ). FPG, HbA1c, SBP, DBP, LDL - C, the control rate and joint control rate of the first four parameters were significantly different before and after the intervention in the intensive group ( P <0. 05 ). FPG, HbA1c, SBP, control rate of FPG, HbA1c, and blood pressure were significantly different before and after the intervention in the standard group ( P <0. 05 ). Conclusion Community - Hospital joint management can improve the control rate and joint control rate of HbA,,. among T2DM patients.