对老年糖尿病慢性并发症患者实施一体化管理的效果评价
대노년당뇨병만성병발증환자실시일체화관리적효과평개
Evaluation on the efficacy of integrated management on elderly type 2 diabetes mellitus patients with chronic complications
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2014年 16期 4-7 ,共4页

    李进%王俊宏%刘艳晓%张志宇%刘惠双%田勇%禹远远%侯卫东%丁红霞

    리진%왕준굉%류염효%장지우%류혜쌍%전용%우원원%후위동%정홍하

    疾病管理%糖尿病%糖尿病并发症%生活质量 疾病管理%糖尿病%糖尿病併髮癥%生活質量
    질병관리%당뇨병%당뇨병병발증%생활질량
    Disease management%Diabetes mellitus%Diabetes complications%Quality of life
    目的 调查老年糖尿病慢性并发症患者的治疗现状,并评价对其实施一体化管理的效果,为促进一体化管理模式的完善和推广提供依据.方法 纳入老年糖尿病慢性并发症患者88例,按患者意愿,纳入传统的自我管理的46例患者作为对照组,纳入医院-社区-家庭一体化管理的42例患者作为一体化组.随访1年,所有患者随访前后均评估汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、生存质量特异性量表(A-DQOL),进行空腹血糖(FPG)、餐后2h血糖(2 h PG)、糖化血红蛋白(HbA1c)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)的测定,并计算治疗2型糖尿病及其并发症的相关医疗费用.结果 两组管理前各项指标比较差异均无统计学意义(P＞0.05).一体化组管理后1年FPG、2hPG、HbA1c、月均低血糖次数、TC、TG、LDL-C、DBP、住院费用、直接医疗费用、HAMA评分、A-DQOL评分均较对照组明显降低[(7.36±1.21) mmol/L比(9.11±1.82) mmol/L、(9.01±2.14)mmol/L比(14.22±3.23)mmol/L、(7.26±1.19)％比(8.84±1.80)％、(0.84±1.08)次/月比(3.13±2.58)次/月、(4.37±0.48)mmol/L比(4.96±0.52) mmol/L、(1.44±0.29) mmol/L比(1.75±0.27) mmol/L、(2.38±0.38) mmol/L比(2.90±0.60) mmol/L、(80.37±10.42) mmHg(1 mmHg=0.133 kPa)比(89.23±14.76) mmHg、(478.70±544.65)元比(977.85±585.35)元、(1 681.92±623.62)元比(1 950.43±563.36)元、(14.50±3.55)分比(17.23±4.28)分、(96.29±15.67)分比(107.90±15.31)分],差异有统计学意义(P＜0.01),SBP、HAMD评分均较对照组降低[(130.66±12.52) mmHg比(138.87±16.41) mmHg、(18.55±4.16)分比(21.10±4.33)分],差异有统计学意义(P＜0.05),月均血糖监测次数较对照组明显增多[(30.55±16.98)次/月比(8.65±7.47)次/月],差异有统计学意义(P＜0.01).结论 对老年糖尿病慢性并发症患者实施个体化治疗策略的一体化管理,可以改善患者的糖脂代谢紊乱,减少住院费用,并且能够改善患者焦虑、抑郁症状及生存质量.
    목적 조사노년당뇨병만성병발증환자적치료현상,병평개대기실시일체화관리적효과,위촉진일체화관리모식적완선화추엄제공의거.방법 납입노년당뇨병만성병발증환자88례,안환자의원,납입전통적자아관리적46례환자작위대조조,납입의원-사구-가정일체화관리적42례환자작위일체화조.수방1년,소유환자수방전후균평고한밀이돈억욱량표(HAMD)、한밀이돈초필량표(HAMA)、생존질량특이성량표(A-DQOL),진행공복혈당(FPG)、찬후2h혈당(2 h PG)、당화혈홍단백(HbA1c)、수축압(SBP)、서장압(DBP)、총담고순(TC)、삼선감유(TG)、저밀도지단백담고순(LDL-C)적측정,병계산치료2형당뇨병급기병발증적상관의료비용.결과 량조관리전각항지표비교차이균무통계학의의(P＞0.05).일체화조관리후1년FPG、2hPG、HbA1c、월균저혈당차수、TC、TG、LDL-C、DBP、주원비용、직접의료비용、HAMA평분、A-DQOL평분균교대조조명현강저[(7.36±1.21) mmol/L비(9.11±1.82) mmol/L、(9.01±2.14)mmol/L비(14.22±3.23)mmol/L、(7.26±1.19)％비(8.84±1.80)％、(0.84±1.08)차/월비(3.13±2.58)차/월、(4.37±0.48)mmol/L비(4.96±0.52) mmol/L、(1.44±0.29) mmol/L비(1.75±0.27) mmol/L、(2.38±0.38) mmol/L비(2.90±0.60) mmol/L、(80.37±10.42) mmHg(1 mmHg=0.133 kPa)비(89.23±14.76) mmHg、(478.70±544.65)원비(977.85±585.35)원、(1 681.92±623.62)원비(1 950.43±563.36)원、(14.50±3.55)분비(17.23±4.28)분、(96.29±15.67)분비(107.90±15.31)분],차이유통계학의의(P＜0.01),SBP、HAMD평분균교대조조강저[(130.66±12.52) mmHg비(138.87±16.41) mmHg、(18.55±4.16)분비(21.10±4.33)분],차이유통계학의의(P＜0.05),월균혈당감측차수교대조조명현증다[(30.55±16.98)차/월비(8.65±7.47)차/월],차이유통계학의의(P＜0.01).결론 대노년당뇨병만성병발증환자실시개체화치료책략적일체화관리,가이개선환자적당지대사문란,감소주원비용,병차능구개선환자초필、억욱증상급생존질량.
    Objective To investigate the current treatment of elderly type 2 diabetes mellitus (T2DM) patients with chronic complications and assess the effect of integrated management on them,so as to provide basis for the improvement and popularization of the mode.Methods Eighty-eight elderly T2DM patients with chronic complications were selected in this study,according to the wishes of the patients,46 cases with traditional way of self-management patients as control group,and 42 cases with hospital-community-family integrated management patients as integrated group,all the patients were followed up for 1 year,all the patients were assessed with Hamilton depression scale (HAMD),Hamilton anxiety scale (HAMA) and the Adjusted Diabetes Quality-of-life Measure (A-DQOL).The fasting plasma glucose(FPG),2-hour postprandial plasma glucose (2 h PG),glycosylated hemoglobin (HbA1c),systolic blood pressure (SBP),diastolic blood pressure (DBP),total cholesterol (TC),triglyceride (TG),and low-density lipoprotein cholesterol (LDL-C) were measured,and the medical costs for treating T2DM and its complications was calculated.Results The index before management between 2 groups had no significant difference (P ＞ 0.05).After management for 1 year,the FPG,2 h PG,HbA1c,frequency of hypoglycemia per month,TC,TG,LDL-C,DBP,hospital costs,direct medical costs,HAMA scores and A-DQOL scores in integrated group were significantly lower than those in control group [(7.36 ± 1.21) mmol/L vs.(9.11 ± 1.82) mmol/L,(9.01 ± 2.14) mmol/L vs.(14.22 ± 3.23) mmol/L,(7.26 ± 1.19)％ vs.(8.84 ± 1.80)％,(0.84 ± 1.08) times/month vs.(3.13 ± 2.58) times/month,(4.37 ± 0.48) mmol/L vs.(4.96 ± 0.52) mmol/L,(1.44 ± 0.29) mmol/L vs.(1.75 ± 0.27) mmol/L,(2.38 ± 0.38) mmol/L vs.(2.90 ± 0.60) mmol/L,(80.37 ± 10.42) mmHg (1 mmHg =0.133 kPa) vs.(89.23 ± 14.76) mmHg,(478.70 ±544.65) yuan vs.(977.85 ±585.35) yuan,(1 681.92 ± 623.62) yuan vs.(1 950.43 ± 563.36) yuan,(14.50 ± 3.55) scores vs.(17.23 ± 4.28) scores,(96.29 ± 15.67) scores vs.(107.90 ± 15.31) scores] (P ＜ 0.01),SBP and HAMA scores were lower than those in control group [(130.66 ± 12.52) mmHg vs.(138.87 ± 16.41) mmHg,(18.55 ± 4.16) scores vs.(21.10 ± 4.33) scores] (P ＜ 0.05),frequency of blood glucose monitoring per month was significantly higher than that in control group [(30.55 ± 16.98) times/month vs.(8.65 ±7.47) times/month] (P ＜0.01).Conclusions In elderly T2DM patients with chronic complications,integrated management with individual treatment strategy can significantly improve metabolic disorders,decrease hospital costs,improve the symptoms of anxiety and depression,and improve quality of life.
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