实用医学杂志 ›› 2022, Vol. 38 ›› Issue (12): 1563-1568.doi: 10.3969/j.issn.1006⁃5725.2022.12.022

• 医院管理 • 上一篇    下一篇

1型糖尿病患者整合医疗管理实施效果分析 

叶凯云 姜关祎清 梁干雄 尚治新 吴伟英    

  1. 广东省中山市人民医院内分泌科(广东中山 528403)

  • 出版日期:2022-06-25 发布日期:2022-06-25
  • 基金资助:
    中山市社会公益科技研究项目(编号:190320152898452);中山市卫生计生专项资金(Ⅰ型糖尿病干预项目)(编号:201508201001197)

Effect of integrated medical management in patients with type 1 diabetes mellitus

YE Kaiyun,JIANG Guanyiqing,LIANG Ganxiong,SHANG Zhixin,WU Weiying.   

  1. Department of Endocrinology,Zhongshan City Peo⁃ ple′s Hospital,Zhongshan 528403,China

  • Online:2022-06-25 Published:2022-06-25

摘要:

目的 分析整合医疗管理对 1 型糖尿病(T1DM)患者的管理效果。方法 纳入符合标准的 T1DM 患者 287 例,对其实施为期 3 年的整合医疗管理,通过政府专项资金,建立治疗中心,为患者提供干 预治疗及门诊规范化的慢性病管理。干预治疗包括提供胰岛素治疗、注射用针头、血糖自我监测(SMBG 器械、定期糖尿病教育及监测各项观察指标。对比管理前、管理 3 年后的观察指标,评估管理效果。 结果 与管理前比较,管理后儿童青少年、成人和老年 T1DM 患者 SMBG 频率、胰岛素强化治疗率均升高 (均 P < 0.01),酮症发生率和住院频次均下降(均 P < 0.05),且儿童青少年 T1DM 患者每日胰岛素剂量升 高(P < 0.01)。与管理前比较,管理后儿童青少年、成人 T1DM 患者餐后 2 h C 肽水平、HbA1c 达标率和运 动达标率均下降(P < 0.05),且成人 T1DM 患者饮食控制率升高(P < 0.01)。结论 整合医疗管理实施有 利于提高 T1DM 患者的自我管理意识和技巧,减少并发症的发生,减轻疾病负担;但尚需引导患者适当开 展运动治疗和控制饮食,以提高管理效果。

关键词:

1型糖尿病, 整合医疗管理, 胰岛素强化治疗, 酮症, 管理效果

Abstract:

Objective To analyze the effect of integrated medical management on patients with type 1 diabetes mellitus(T1DM). Methods A total of287 T1DM patients were enrolled in this study,and integrated medical management was implemented for them for three years. Through special government funds,a treatment center was established to provide patients with therapeutic intervention and standardized chronic disease management in the outpatient department. Interventions included insulin therapy,injection needles,blood glucose self ⁃ monitoring (SMBG)devices,regular diabetes education,and observation indicator monitoring.The management effect was evaluated by comparing the observation indicators before and after the management for three years. Results SMBG frequency and intensive insulin therapy rate of T1DM patients in children and adolescents,adults and the elderly increased after the management(all < 0.01),but the ketosis incidence and hospitalization frequency decreased (all < 0.05),and daily insulin dose of T1DM patients in children and adolescents increased(< 0.01). Compared with those before the management,the 2 h postprandial c ⁃ peptide level,HbA1c compliance rate and exercise compliance rate of T1DM patients in children and adolescents and adults decreased(all < 0.05),and dietary control rate of adult T1DM patients increased(< 0.01). Conclusion Integrated medical management is effective for improving self ⁃management awareness and skills of T1DM patients,reducing the occurrence of complications and medical cost. However,it is still necessary for patients to have exercise and diet control to strengthen the management effect.

Key words:

type 1 diabetes mellitus, integrated medical management mode, intensive insulin therapy, ketosis, management effect