CAJ | 학술논문

目的探讨“胰岛素管理单元”模式与常规治疗模式相比,对本社区血糖控制不佳且接受胰岛素治疗的2型糖尿病患者的干预效果.方法 (1)筛选出在本院糖尿病门诊建档,HbA1C≥8％且注射胰岛素的2型糖尿病患者55例,分为标准组及强化组,分组前均进行糖尿病知识教育并采集个人信息、生化检查、空腹血糖、HbAIC、并记录目前治疗方案、每日胰岛素剂量、每月低血糖发生频率；(2)强化组患者免费提供血糖仪一台,要求每日至少自我监测血糖2～3次,社区医生每周电话随访一次,询问血糖监测、低血糖发生等情况并指导方案调整,每月门诊随访一次.标准组每月常规门诊就诊一次或以上,由同一医生根据情况调整治疗方案.两组患者随访时间均为6个月,分别在第3个月及研究结束时复查血糖、生化、HbA1C等指标,并记录2组每日胰岛素剂量及自我上报的低血糖发生频率.结果标准组及强化组患者HbA1C从基线时的9.14％±1.24％、9.33％±1.14％分别降至8.65％±1.28％、7.40％±0.91％；2组基线时自测血糖频率为4次/月,干预后强化组的血糖自测频率明显增高(5次/月对50次/月,P＜0.01);干预后强化组自我上报低血糖概率增高(1次/月对3次/月,P＜0.01);强化组最高胰岛素每日平均剂量较基线时增加6U,但无统计学差异.结论通过6个月的强化管理能使注射胰岛素患者的血糖控制明显改善,且未明显增加胰岛素剂量,此“胰岛素管理单元”模式安全有效.
목적 탐토“이도소관리단원”모식여상규치료모식상비,대본사구혈당공제불가차접수이도소치료적2형당뇨병환자적간예효과.방법 (1)사선출재본원당뇨병문진건당,HbA1C≥8％차주사이도소적2형당뇨병환자55례,분위표준조급강화조,분조전균진행당뇨병지식교육병채집개인신식、생화검사、공복혈당、HbAIC、병기록목전치료방안、매일이도소제량、매월저혈당발생빈솔；(2)강화조환자면비제공혈당의일태,요구매일지소자아감측혈당2～3차,사구의생매주전화수방일차,순문혈당감측、저혈당발생등정황병지도방안조정,매월문진수방일차.표준조매월상규문진취진일차혹이상,유동일의생근거정황조정치료방안.량조환자수방시간균위6개월,분별재제3개월급연구결속시복사혈당、생화、HbA1C등지표,병기록2조매일이도소제량급자아상보적저혈당발생빈솔.결과 표준조급강화조환자HbA1C종기선시적9.14％±1.24％、9.33％±1.14％분별강지8.65％±1.28％、7.40％±0.91％；2조기선시자측혈당빈솔위4차/월,간예후강화조적혈당자측빈솔명현증고(5차/월대50차/월,P＜0.01);간예후강화조자아상보저혈당개솔증고(1차/월대3차/월,P＜0.01);강화조최고이도소매일평균제량교기선시증가6U,단무통계학차이.결론 통과6개월적강화관리능사주사이도소환자적혈당공제명현개선,차미명현증가이도소제량,차“이도소관리단원”모식안전유효.
Objective To assess the impact of intervention with "Insulin therapy management unit" program in the poorly controlled type 2 diabetic patients in a community of Shanghai.Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia (HbA1C ≥ 8％) enrolled in this study.They were divided at random into 2 groups:intensive care group and standard care group.The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day.Community health provider acquired information of blood glucose level,episodes of hypoglycemia,and dosage of insulin every week by cell phone.Standard care patients received diabetes care from the same provider in outpatient clinic every month.Results By the end of 6 months of intervention,the intensive care group showed a significant difference in HbA1C as compared to the standard care group (7.40％ ±0.91％ vs 8.65 ％ ± 1.28％,P＜0.01).The frequency of self-monitoring of blood glucose (SMBG) was 4 times per month in both groups at baseline.After intervention,the frequency of SMBG in intensive care group was greatly increased compared to standard care group (50times per month vs 5 times per month,P＜0.01).The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group (3 times per month vs once per month,P＜0.01).The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study(P＞0.05).Conclusion After 6 months of intervention,the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly.The " Insulin therapy management unit" is effective and safe.