CAJ | 학술논문

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HbA1 c、胆固醇、LDL-C达标率显著升高(分别为55.8% υs 29.9%,68.8% υs 56.5%,74.2% υs 54.0%,P<0.05);干预后36个月和54个月,强化组较标准组HbA1c达标率显著升高(36个月为73.1%υs24.3%,54个月为80.3%υs24.6%,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、HbA1c、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%;HbA1c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%υs67.3%,P<0.05);磺脲类和胰岛素明显增加(分别为70.2%υs54.0%,21.3%υs12.0%,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.
목적 대사구300례당뇨병환자강화관리화치료적효과평개.방법 당뇨병환자300례수궤분위강화치료조(n=145)화표준치료조(n=155),대강화조진행강화종합간예、강화공제체표、규범수방;표준조급여상규문진치료관리,위기54개월.결과 강화조여표준조비교,간예후18개월HbA1 c、담고순、LDL-C체표솔현저승고(분별위55.8% υs 29.9%,68.8% υs 56.5%,74.2% υs 54.0%,P<0.05);간예후36개월화54개월,강화조교표준조HbA1c체표솔현저승고(36개월위73.1%υs24.3%,54개월위80.3%υs24.6%,P<0.05).강화조입조전화간예후18개월、36개월、54개월4차비교·혈압、공복혈당、HbA1c、담고순、HDL-C、용약정황급월화비차이균유통계학의의(P<0.05).혈압체표솔4차분별위57.6%、59.3%、60.5%、83.1%;HbA1c위46.2%、55.8%、73.1%、80.3%;담고순위42.1%、68.8%、63.2%、62.9%;HDL-C위70.5%、87.5%、81.6%、81.4%.입조후18개월강화조쌍고류약물소점비례교표준조소(56.1%υs67.3%,P<0.05);광뇨류화이도소명현증가(분별위70.2%υs54.0%,21.3%υs12.0%,P<0.05);강당약월화비강화조증가134.5원,상승53.6%,표준조증가70.5원,상승29.8%.결론 사구강화간예가이사혈당득도량호공제,혈압、혈지교이상공제,화비략증.
Objective To evaluate the effects of an intensified community-based management and treatment on abnormal levels of glucose,blood pressure and lipids in 300 diabetic patients. MethodsThe study included an intensified management group (n=145) and conventional treatment group (n=155). The intensified group was treated with strengthened comprehensive intervention, self blood glucose monitoring, and regular visit at least once a month, while the conventional group was treated as usually in the community medical center for 54 months. The blood glucose and lipids and blood pressure as well as medical cost in two groups were evaluated after 18 months′, 36 months′ and 54 months′ treatment. Results After 18 months′ treatment, the target arrival rates of HbA1c, TC and LDL-C in the intensified group (55.8%, 68.8% and 74.2% respectively) were significantly higher than in conventional group (29.9%, 56.5% and 54.0%, all P<0.05). After 36 and 54 months′ treatment, the target arrival rate of HbA1c< 6.5% (73.1% vs 24.3% and 80.3% vs 24.6%,all P<0.05) was significantly higher in the intensified group than in conventional group. Blood pressure, fasting blood-glucose, HbA1c, cholesterol, HDL-C, and monthly medical cost were all different significantly among baseline, 18, 36 and 54 months′ treatment (all P<0.05). The target arrival rates of blood pressure at baseline and 18, 36 and 54 months treatment were 57.6%, 59.3%, 60.5% and 83.1% in the intensified group and 46.2%, 55.8%, 73.1% and 80.3% in the conventional group. The percentages of intensified group with cholesterol < 5.17 mmol/L were 42.1%, 68.8%, 63.2%, 62.9%, respectively ,and those with HDL-C target arrival were 70.5%,87.5%, 81.6% and 81.4%. All of lipids profiles levels were much better in intensified group than in conventional group.In intensified versus conventional group, the overall proportion of medication was less for biguanides (56% vs 67%) and was more for sulfonylurea (70% vs 21%) and insulin (54% vs 12%)(all P<0.05). The medical cost was increased by 134.5 yuan (54%) and 70.5 Yuan RMB (30%) monthly per person in the intensified group and in conventional group respectively. Conclusion The intensified community-based treatment shows a better therapeutic effect in controlling hyperglycemia, hypertension and dyslipidemia than the conventional treatment, but with slightly increased monthly medical cost.