糖尿病,2型%疾病管理%血糖控制
糖尿病,2型%疾病管理%血糖控製
당뇨병,2형%질병관리%혈당공제
Diabetes mellitus,type 2%Disease management%Glucose control
目的 针对三甲医院的特点,探索糖尿病的一体化管理模式的效果.方法 人选2010年6月至2011年6月收治的380例应用胰岛素治疗且无高血压的2型糖尿病患者,采用Excel随机抽样方法分为2组(管理组和对照组),各190例患者.其中管理组患者男性91例,女性99例,年龄(54±8)岁,体质指数(BMI) (25±3)kg/m2,病程(8±3)年,对照组患者男性88例,女性102例,年龄(56±7)岁,BMI(26±3)kg/m2,病程(8±3)年,两组一般资料具有可比性.管理组对患者进行一体化糖尿病管理,对照组按三甲医院的常规方式治疗.疗程均为6个月.对两组干预前后效果进行对比分析.两组均数的比较用t检验,方差不齐时用t′检验.结果 治疗后,管理组和对照组空腹血糖、餐后2h血糖、糖化血红蛋白、生活满意度及自信心均较治疗前有明显改善,治疗前后差异均有统计学意义(t′=- 182.81 ～27.74,均P＜0.05).对照组BMI较治疗前显著增加,差异有统计学意义[(29±4)比(26±3)kg/m2,t′=- 10.51,P＜0.05],而管理组BMI未见显著增加,差异无统计学意义[(26±3)比(25 ±3) kg/m2,t=1.65,P＞0.05].治疗后,管理组BMI明显低于对照组,差异有统计学意义(t′=-9.47,P＜0.05).管理组生活满意度、自信心均显著高于对照组,差异均有统计学意义(分别为96％±4％、95％±4％和62％±10％、60％±11％,t′=42.60、41.69,均P＜0.05)；管理组的胰岛素用量及每日药物费用均显著低于对照组[分别为(0.38 ±0.03) 、(0.55±0.07)U·kg-1·d-1和(11±3)、(16±6)元/d,t′=-30.77、-9.21,均P＜0.05].结论 糖尿病一体化管理使血糖控制更好,患者更有自信心,而所用的每日药物费用则下降了27.8％.在目前医疗费用超标的情况下,该管理模式值得临床推广.
目的 針對三甲醫院的特點,探索糖尿病的一體化管理模式的效果.方法 人選2010年6月至2011年6月收治的380例應用胰島素治療且無高血壓的2型糖尿病患者,採用Excel隨機抽樣方法分為2組(管理組和對照組),各190例患者.其中管理組患者男性91例,女性99例,年齡(54±8)歲,體質指數(BMI) (25±3)kg/m2,病程(8±3)年,對照組患者男性88例,女性102例,年齡(56±7)歲,BMI(26±3)kg/m2,病程(8±3)年,兩組一般資料具有可比性.管理組對患者進行一體化糖尿病管理,對照組按三甲醫院的常規方式治療.療程均為6箇月.對兩組榦預前後效果進行對比分析.兩組均數的比較用t檢驗,方差不齊時用t′檢驗.結果 治療後,管理組和對照組空腹血糖、餐後2h血糖、糖化血紅蛋白、生活滿意度及自信心均較治療前有明顯改善,治療前後差異均有統計學意義(t′=- 182.81 ～27.74,均P＜0.05).對照組BMI較治療前顯著增加,差異有統計學意義[(29±4)比(26±3)kg/m2,t′=- 10.51,P＜0.05],而管理組BMI未見顯著增加,差異無統計學意義[(26±3)比(25 ±3) kg/m2,t=1.65,P＞0.05].治療後,管理組BMI明顯低于對照組,差異有統計學意義(t′=-9.47,P＜0.05).管理組生活滿意度、自信心均顯著高于對照組,差異均有統計學意義(分彆為96％±4％、95％±4％和62％±10％、60％±11％,t′=42.60、41.69,均P＜0.05)；管理組的胰島素用量及每日藥物費用均顯著低于對照組[分彆為(0.38 ±0.03) 、(0.55±0.07)U·kg-1·d-1和(11±3)、(16±6)元/d,t′=-30.77、-9.21,均P＜0.05].結論 糖尿病一體化管理使血糖控製更好,患者更有自信心,而所用的每日藥物費用則下降瞭27.8％.在目前醫療費用超標的情況下,該管理模式值得臨床推廣.
목적 침대삼갑의원적특점,탐색당뇨병적일체화관리모식적효과.방법 인선2010년6월지2011년6월수치적380례응용이도소치료차무고혈압적2형당뇨병환자,채용Excel수궤추양방법분위2조(관리조화대조조),각190례환자.기중관리조환자남성91례,녀성99례,년령(54±8)세,체질지수(BMI) (25±3)kg/m2,병정(8±3)년,대조조환자남성88례,녀성102례,년령(56±7)세,BMI(26±3)kg/m2,병정(8±3)년,량조일반자료구유가비성.관리조대환자진행일체화당뇨병관리,대조조안삼갑의원적상규방식치료.료정균위6개월.대량조간예전후효과진행대비분석.량조균수적비교용t검험,방차불제시용t′검험.결과 치료후,관리조화대조조공복혈당、찬후2h혈당、당화혈홍단백、생활만의도급자신심균교치료전유명현개선,치료전후차이균유통계학의의(t′=- 182.81 ～27.74,균P＜0.05).대조조BMI교치료전현저증가,차이유통계학의의[(29±4)비(26±3)kg/m2,t′=- 10.51,P＜0.05],이관리조BMI미견현저증가,차이무통계학의의[(26±3)비(25 ±3) kg/m2,t=1.65,P＞0.05].치료후,관리조BMI명현저우대조조,차이유통계학의의(t′=-9.47,P＜0.05).관리조생활만의도、자신심균현저고우대조조,차이균유통계학의의(분별위96％±4％、95％±4％화62％±10％、60％±11％,t′=42.60、41.69,균P＜0.05)；관리조적이도소용량급매일약물비용균현저저우대조조[분별위(0.38 ±0.03) 、(0.55±0.07)U·kg-1·d-1화(11±3)、(16±6)원/d,t′=-30.77、-9.21,균P＜0.05].결론 당뇨병일체화관리사혈당공제경호,환자경유자신심,이소용적매일약물비용칙하강료27.8％.재목전의료비용초표적정황하,해관리모식치득림상추엄.
Objective To investigate the effectiveness of integrative diabetes management in thirdgrade class-A hospital.Method Three hundred and eighty insulin-na(i)ve type 2 diabetic patients who were going on insulin therapy were enrolled from June 2010 to June 2011.The patients were divided into 2 groups with Excel random sampling,190 cases in each group:the management group,91 males and 99 females,aged (54 ± 8 ) years with a body mass index( BMI ) of (25 ± 3 ) kg/m2 and a duration of disease of ( 8 ± 3 )years ; the control group,88 males and 102 females,aged ( 56 ± 7 ) years with a BMI of ( 26 ± 3 ) kg/m2 and a duration of disease of ( 8 ± 3 ) years,the baseline information was comparable between the two groups.Patients in management group received intensive integrative diabetic management and those in control group were given routine therapy for 6 months.The therapeutie effects were compared before and after the treatment and between the groups.The data of the two groups were compared with t test or t′ test.Results Fasting plasma glucose,two-hour postprandial plasma glucose,glycated hemoglobin A1c,satisfaction on life and self-confidence at the end of the treatments were all significantly improved compared with those before the therapy in both groups (t′ =-182.81,-27.74,P ＜0.05 ).The BMI in control group was significantly higher than that before treatment ((29±4) vs (26 ±3) kg/m2,t′=-10.51,P＜0.05),while no significant difference was found in BMI in the management group after the treatment ( (26 ± 3 ) vs (26± 3 )kg/m2,t =1.65,P ＞0.05). The BMI in management group was significantly higher than that in control group at the end of the treatment ( t′ =- 9.47,P ＜ 0.05 ). Satisfaction on life and self-confidence of the patients in the management group significantly improved compared with those in the control group (96％ ±4％,95％ ±4％ and 62％ ± 10％,60％ ± 11％,respectively; t′ =42.60,41.69,both P ＜ 0.05 ).The daily insulin dosage and mean daily expenses in the management group were significantly lower than those in the control group( (0.38 ±0.03 ) vs (0.55 ±0.07) U · kg-1 · d -1 and (11 ±3) vs (16±6) yuan/d,t′=- 30.77,- 9.21,P ＜ 0.05 ). Conclusion Integrative diabetes management can achieve a better glucose control with less insulin dose,higher self-confidence and less drug expenses with a drop of 27.8％. In the current conditions of excessive medical costs,this practice is worthy to be expanded clinically.
