目的:本研究旨在探讨通过强调餐后2小时血糖监测,采用家庭医生团队管理模式对老年糖尿病患者血糖控制效果进行评价,进而为家庭医生团队管理模式是否需要强化餐后2小时血糖监测提供切实证据。方法:本研究采取前瞻性队列研究,连续入选重庆市渝北区大湾中心卫生院2020-06~2020-12参加老年人免费体检,且确诊为2型糖尿病的患者共481例,其中4人因外出等原因被剔除,采用随机数字表法将患者分为对照组和干预组。其中对照组(女性142例,男性96例,n = 238):只接受常规家庭医生团队管理,在对患者进行糖尿病随访时只监测空腹血糖。干预组(女性147例,男性92例,n = 239):对患者进行糖尿病随访时不仅监测空腹血糖,还须监测餐后2小时血糖。同一时间段分别采取不同的管理模式,干预12个月后,再次检测并比较两组糖化血红蛋白(HbAlc)、空腹血糖(FBG)、餐后2小时血糖(2h-PBG)、血脂、舒张压(DBP)、收缩压(SBP)、体质指数(BMI)等指标,应用SPSS 22.0软件进行统计分析。对正态分布的资料采用t检验,P < 0.05表明差异具有统计学意义。结果:经为期12月的家庭医生团队管理后,两组BMI、HDL-C、TC等指标间差异无统计学意义(P > 0.05);干预组FBG、2h-PBG、HbAlc及TG、LDL-C、舒张压、收缩压等均优于对照组,差异具有统计学意义(P < 0.05)。结论:强调餐后2小时血糖监测的家庭医生团队管理模式,能够有效控制糖尿病患者血糖及血脂水平,具有临床推广应用价值。 Objective: The study aims to evaluate the effect of family doctor team management on the glycemic control of elderly diabetic patients in the community by emphasizing 2 hours postprandial blood glucose monitoring, so as to provide tangible evidence for whether the family doctor team management mode needs to strengthen the 2 hour postprandial blood glucose monitoring. Methods: A prospective cohort study was conducted. 481 consecutive patients were enrolled in the 2020-06~2020-12 of the Da Wan Health Center in Yubei District, Chongqing. 481 of them were diagnosed with type 2 diabetes and 4 were excluded for reasons such as going out. The patients were randomly divided into control group (142 females, 96 males, n = 238): Only received routine family doctor team management, only fasting blood glucose was monitored during follow-up. Intervention group (147 women, 92 men, n = 239): Fasting blood glucose and 2-hour postprandial blood glucose were monitored during follow-up. At the same time, different management modes were adopted. After 12 months of intervention, BMI, SBP, DBP, HbAlc, FBG, 2h-PBG of two groups were detected and compared again. SPSS 22.0 software was used for statistical analysis. The data of normal distribution were tested by t-test, P < 0.05, which showed that the difference was statistically significant. Results: Comparison of the changes of the above indexes between the two groups before and after intervention: After 12 months of family doctor team management, there was no significant difference between the two groups in BMI, HDL-C, TC and other indexes (P > 0.05); FBG, 2h-PBG, HbAlc, TG, LDL-C, diastolic blood pressure and systolic blood pressure in the intervention group were better than those in the control group (P < 0.05), the results showed that the difference was statistically significant. Conclusion: The family doctor team management mode emphasizing 2 hours postprandial blood glucose monitoring can effectively control the blood sugar and blood lipid level of diabetics, and is worthy of clinical popularization and application.
目的:本研究旨在探讨通过强调餐后2小时血糖监测,采用家庭医生团队管理模式对老年糖尿病患者血糖控制效果进行评价,进而为家庭医生团队管理模式是否需要强化餐后2小时血糖监测提供切实证据。方法:本研究采取前瞻性队列研究,连续入选重庆市渝北区大湾中心卫生院2020-06~2020-12参加老年人免费体检,且确诊为2型糖尿病的患者共481例,其中4人因外出等原因被剔除,采用随机数字表法将患者分为对照组和干预组。其中对照组(女性142例,男性96例,n = 238):只接受常规家庭医生团队管理,在对患者进行糖尿病随访时只监测空腹血糖。干预组(女性147例,男性92例,n = 239):对患者进行糖尿病随访时不仅监测空腹血糖,还须监测餐后2小时血糖。同一时间段分别采取不同的管理模式,干预12个月后,再次检测并比较两组糖化血红蛋白(HbAlc)、空腹血糖(FBG)、餐后2小时血糖(2h-PBG)、血脂、舒张压(DBP)、收缩压(SBP)、体质指数(BMI)等指标,应用SPSS 22.0软件进行统计分析。对正态分布的资料采用t检验,P < 0.05表明差异具有统计学意义。结果:经为期12月的家庭医生团队管理后,两组BMI、HDL-C、TC等指标间差异无统计学意义(P > 0.05);干预组FBG、2h-PBG、HbAlc及TG、LDL-C、舒张压、收缩压等均优于对照组,差异具有统计学意义(P < 0.05)。结论:强调餐后2小时血糖监测的家庭医生团队管理模式,能够有效控制糖尿病患者血糖及血脂水平,具有临床推广应用价值。
家庭医生团队管理,2型糖尿病,餐后2小时血糖,空腹血糖
Rui Shu1, Guiqiong Li2
1Chongqing Medical University, Chongqing
2The Second Affiliated Hospital of Chongqing Medical University, Chongqing
Received: Feb. 23rd, 2022; accepted: Mar. 15th, 2022; published: Mar. 28th, 2022
Objective: The study aims to evaluate the effect of family doctor team management on the glycemic control of elderly diabetic patients in the community by emphasizing 2 hours postprandial blood glucose monitoring, so as to provide tangible evidence for whether the family doctor team management mode needs to strengthen the 2 hour postprandial blood glucose monitoring. Methods: A prospective cohort study was conducted. 481 consecutive patients were enrolled in the 2020-06~2020-12 of the Da Wan Health Center in Yubei District, Chongqing. 481 of them were diagnosed with type 2 diabetes and 4 were excluded for reasons such as going out. The patients were randomly divided into control group (142 females, 96 males, n = 238): Only received routine family doctor team management, only fasting blood glucose was monitored during follow-up. Intervention group (147 women, 92 men, n = 239): Fasting blood glucose and 2-hour postprandial blood glucose were monitored during follow-up. At the same time, different management modes were adopted. After 12 months of intervention, BMI, SBP, DBP, HbAlc, FBG, 2h-PBG of two groups were detected and compared again. SPSS 22.0 software was used for statistical analysis. The data of normal distribution were tested by t-test, P < 0.05, which showed that the difference was statistically significant. Results: Comparison of the changes of the above indexes between the two groups before and after intervention: After 12 months of family doctor team management, there was no significant difference between the two groups in BMI, HDL-C, TC and other indexes (P > 0.05); FBG, 2h-PBG, HbAlc, TG, LDL-C, diastolic blood pressure and systolic blood pressure in the intervention group were better than those in the control group (P < 0.05), the results showed that the difference was statistically significant. Conclusion: The family doctor team management mode emphasizing 2 hours postprandial blood glucose monitoring can effectively control the blood sugar and blood lipid level of diabetics, and is worthy of clinical popularization and application.
Keywords:Family Doctor Team Management, Type 2 Diabetes Mellitus, 2-Hour Postprandial Blood Glucose, Fasting Blood Glucose
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糖尿病是全球性公共卫生问题,且我国糖尿病患病人数高,居世界第一,糖尿病是继心脑血管疾病、肿瘤之后另一个严重危害我国人民健康的慢性非传染性疾病 [
连续入选重庆市渝北区大湾中心卫生院2020-06~2020-12参加老年人免费体检,且确诊为2型糖尿病的患者481例,最终4人因外出等原因剔除,并随机分为对照组(女性142例,男性96例,n = 238)和干预组(女性147例,男性92例,n = 239)。入选标准:① 符合中国2型糖尿病防治指南2020年版本,明确诊断为糖尿病;② 本地区常住居民,居住时间超过1年;③ 具有正常思维与理解能力,可与医护人员有效沟通,并自愿参与到本研究当中。排除标准:① 合并有认知功能障碍、精神疾病、严重心脑血管疾病、恶性肿瘤患者或生活无法自理者;② 妊娠或哺乳期妇女;③ 拒绝加入研究者。本研究上报渝北区大湾中心卫生院医学伦理委员会审核并最终通过。
对入选本次研究的患者,分别进行年龄、性别、病程等一般资料的收集。
家庭医生团队包括一名全科医师、一名公共卫生医师及一名社区护士。其中全科医师负责2型糖尿病患者的健康评估、疾病诊治、健康管理方案制定、门诊咨询、义诊咨询、健康教育等工作。社区护士负责患者档案建立、健康情况收集、家庭医生签约、生理指标检测、通过短信反馈健康信息、电话及现场随访等工作。公卫医师负责宣传资料分发、义诊咨询、微信群消息推送等。
对照组:本组患者仅给予常规家庭医生团队管理。
干预组:本组患者实行强调餐后2小时血糖监测的家庭医生团队管理模式。即进行2型糖尿病患者随访时严格按照要求对其进行餐后2小时血糖监测,并对其进行相关健康教育及指导,测量后与临床标准进行对比,并根据结果进行个体化饮食教育、药物治疗方案调整等。
1) 患者血糖控制效果良好(FBG低于7.0 mmol/L,同时2h-PBG低于10.0 mmol/L),使用药物过程中未出现不良反应,除原有并发症之外未出现其他类型并发症,或原有并发症较为稳定,根据情况进行下一次随访预约。
2) 患者首次血糖控制不佳(FBG达到或超过7.0 mmol/L或2h-PBG达到或超过10.0 mmol/L)或使用药物后出现不良反应,根据患者用药依从情况进行相应指导,适当对现有药量进行增加,或者尝试换用其他降糖药物,用药2周后随访。
3) 患者出现连续血糖控制不佳或用药后不良反应无法或很难控制,以及有新类型并发症出现或原有并发症持续加重,建议并协助患者转诊至上级医院,2周内随访其血糖控制情况。
4) 对患者进行针对性的健康教育,了解患者生活方式,改正不良习惯并制定改进目标与实施计划,在下一次进行随访时对实施进展进行评估。
干预组与对照组均进行为期12个月的家庭医生团队管理,干预前后分别对两组患者的体质指数(BMI)、空腹血糖(FBG)、餐后2小时血糖(2h-PBG)、糖化血红蛋白(HbAlc)和高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)等血脂指标以及舒张压(DBP)、收缩压(SBP)进行检测 [
本研究相关数据资料整理、编码后建立EXCEL数据集,再录入至SPSS 22.0软件进行统计分析,对正态分布的资料采用( x ¯ ± s )表示,对应进行t检验,计数资料采用n (%)表示,对应采用χ2检验,以输出结果中P < 0.05为差异有统计学意义的指标。
一般资料方面,两组年龄、性别等差异无统计学意义(P > 0.05),如表1所示。
组别 | 例数 | 年龄(岁) | 性别(男/女) | 病程(年) |
---|---|---|---|---|
干预组 | 239 | 66.85 ± 7.23 | 92/147 | 8.32 ± 2.73 |
对照组 | 238 | 67.23 ± 7.42 | 96/142 | 8.38 ± 2.79 |
t/χ2 | 0.566 | 0.170 | 0.237 | |
P | 0.571 | 0.681 | 0.812 |
表1. 两组一般资料比较
经为期12月的家庭医生团队管理后,两组BMI、HDL-C、TC等指标间差异无统计学意义(P > 0.05);干预组FBG、2h-PBG、HbAlc及TG、LDL-C、舒张压、收缩压等均优于对照组,差异具统计学意义(P < 0.05),如表2~5所示。
组别 | 例数 | FBG (mmol/L) | 2h-PBG (mmol/L) | HbAlc (%) | |||
---|---|---|---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | 干预前 | 干预后 | ||
观察组 | 239 | 8.62 ± 2.31 | 7.27 ± 2.14 | 12.93 ± 2.73 | 10.69 ± 2.52 | 8.43 ± 0.87 | 7.42 ± 0.75 |
对照组 | 238 | 8.61 ± 2.34 | 8.22 ± 2.26 | 13.01 ± 2.77 | 12.53 ± 2.36 | 8.39 ± 0.89 | 8.21 ± 0.72 |
t | 0.047 | 4.714 | 0.318 | 8.230 | 0.496 | 11.734 | |
P | 0.963 | 0.000 | 0.751 | 0.000 | 0.620 | 0.000 |
表2. 两组FBG、2h-PBG及HbAlc指标干预前后比较( x ¯ ± s )
组别 | 例数 | TG | HDL-C | LDL-C | |||
---|---|---|---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | 干预前 | 干预后 | ||
观察组 | 239 | 1.96 ± 1.15 | 1.31 ± 0.35 | 1.21 ± 0.33 | 1.29 ± 0.36 | 3.17 ± 1.16 | 2.43 ± 0.97 |
对照组 | 238 | 1.99 ± 1.17 | 1.75 ± 0.41 | 1.23 ± 0.34 | 1.32 ± 0.37 | 3.14 ± 1.09 | 3.05 ± 1.02 |
t | 0.282 | 12.607 | 0.652 | 0.897 | 0.291 | 6.803 | |
P | 0.778 | 0.000 | 0.515 | 0.370 | 0.771 | 0.000 |
表3. 两组TG、HDL-C、LDL-C干预前后比较( x ¯ ± s )
组别 | 例数 | BMI | TC | ||
---|---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | ||
观察组 | 239 | 25.67 ± 4.04 | 25.31 ± 3.77 | 5.03 ± 1.27 | 4.87 ± 1.19 |
对照组 | 238 | 25.73 ± 3.97 | 25.52 ± 3.81 | 4.99 ± 1.24 | 4.95 ± 1.21 |
t | 0.164 | 0.605 | 0.348 | 0.728 | |
P | 0.870 | 0.545 | 0.728 | 0.467 |
表4. 两组BMI、TC干预前后比较( x ¯ ± s )
组别 | 例数 | 舒张压 | 收缩压 | ||
---|---|---|---|---|---|
干预前 | 干预后 | 干预前 | 干预后 | ||
观察组 | 239 | 92.45 ± 8.69 | 81.29 ± 6.65 | 153.36 ± 18.93 | 131.69 ± 10.75 |
对照组 | 238 | 92.56 ± 8.73 | 87.58 ± 6.71 | 152.77 ± 19.21 | 143.67 ± 13.67 |
t | 0.138 | 10.283 | 0.338 | 10.641 | |
P | 0.890 | 0.000 | 0.736 | 0.000 |
表5. 两组血压干预前后比较( x ¯ ± s )
2型糖尿病患者血糖达标的一个重要条件即为定期血糖监测。临床资料显示,多种慢性并发症的发生与发展均与患者血糖控制的结果存在密切关联。在糖尿病的临床治疗中,血糖监测占有重要地位 [
本研究中,干预组应用强调餐后2小时血糖监测的家庭医生团队管理模式,结果显示,经过12个月的干预,干预组HbAlc、FBG、2h-PBG、LDL-C、TG、DBP、SBP等均低于干预前及同期对照组,差异均具统计学意义(P < 0.05)。这表明在家庭医生团队管理模式中强化餐后2小时血糖监测可对2型糖尿病患者血糖控制效果进行有效提升。分析原因,监测餐后2小时血糖,时间上易与患者休息或工作时间发生冲突,患者在无医师特别强调的情况下主动监测的依从性很低 [
综上所述,对2型糖尿病患者应用强调餐后2小时血糖监测的家庭医生团队管理模式,能够有效控制其血糖及血脂水平,具临床推广应用价值。
课题:重庆市卫生局科研项目“颈动脉粥样硬化的超声与血管造影的临床应用研究”(2007-B-103)、重庆市卫计委中医药科研项目“参附注射液通过SIRT1通路促进梗死心肌细胞存活的机制”(ZY20150244)。
舒 芮,李桂琼. 强调餐后2小时血糖监测的家庭医生团队管理模式对2型糖尿病患者血糖管理效果评价Evaluation of the Effect of Family Doctor Team Management on Blood Glucose Management in Patients with Type 2 Diabetes after 2-Hour Postprandial Blood Glucose Monitoring[J]. 临床医学进展, 2022, 12(03): 2341-2347. https://doi.org/10.12677/ACM.2022.123337