社区干预对糖尿病并发视网膜病变患者治疗依从性及效果的影响

目的 观察社区干预对2型糖尿病（DM）并发视网膜病变（DR）患者治疗依从性及效果的影响。方法 2012年5月至2014年6月在桂林市人民医院及象山社区卫生服务中心纳入的678例2型DM患者中筛查，选择确诊并发DR 148例（296只眼），随机分为干预组和对照组各74例（148只眼），对照组行常规健康档案慢性病管理，干预组在对照组基础上进行社区干预，包括社区医护团队和眼科、内分泌科专科医师联合干预、定期检查眼底、签订家庭签约式服务及心理干预，观察2年，评价两组的依从性和干预效果。结果 干预组DM患者的依从性增加，血糖控制率比对照组普遍提高，两组比较差异有统计学意义（P<0.05），干预组视网膜病变发展缓于对照组，两组比较差异有统计学意义（P<0.05）。结论 社区干预能提高辖区2型DM患者治疗依从性及血糖控制率，对及早发现DR、保护视力、控制血糖、提高生存质量有积极的作用。

Effects of community interventions on treatment adherence and efficacy in patients with diabetic retinopathy

Objective To observe the effects of community interventions on treatment adherence and efficacy in the patients with type II diabetes mellitus (DM) combined with diabetic retinopathy (DR). Methods From May 2012 to Jun 2014, 148 cases of DR patients screened and diagnosed from 678 cases of type II DM patients in the area of Guilin Xiangshan, were collected and randomly divided into the intervention group and the control group, 74 cases or 148 eyes in each group. Patients in the two groups were managed with chronic disease records, and the intervention group underwent additional 2-year community interventions, including concerted interventions by community healthcare team and specialists in ophthalmology and endocrinology, regular fundus oculi examination, signing service of family physician, and psychological intervention. Then the intervention efficacy and adherence in the two groups were evaluated and compared. Results Compliance with regular examination and intensive glucose control in the intervention group was much better, together with a more higher glucose control rate, than that in the control group, and the differences between the two groups were statistically significant (P<0.05). There was slower retinopathy development in the intervention group, with significant difference between them (P<0.05). Conclusion The implementation of community interventions in the type II DM patients administered could improve the treatment compliance and level of blood glucose control, which is helpful to diagnose DR early, protect vision, control blood glucose and improve quality of life.