2型糖尿病患者心血管风险评估及社区综合干预临床观察

目的探讨2型糖尿病（T2DM）患者心血管风险评估及社区综合干预的临床观察。方法将196例T2DM患者随机分为社区干预组（观察组）130例、对照组66例。两组均行基础治疗;观察组加行健康教育、饮食治疗、运动治疗、合理用药指导等。检测两组BM I、腰围、血压、血糖、血脂、尿微量白蛋白、C反应蛋白等指标,观察各组转归及其对心血管及替代终点事件的影响。结果随访6、18个月,与对照组比较,观察组多重心血管危险因素明显改善,心血管事件发生率明显降低,残余血管风险降低（P〈0.05或〈0.01）。结论 T2DM患者存在心血管多重危险因素,社区干预可为心血管病高危人群提供系统服务,具有重要的临床和卫生经济学意义。     

健康干预对社区2型糖尿病患者生活质量的影响

目的探讨健康干预对社区2型糖尿病患者生活质量的影响。方法采用调查问卷方式对社区健康服务中心182例糖尿病患者糖尿病知识、自我护理能力、糖尿病代谢各种自控指标、生活满意度进行健康管理前后的评估,同时根据评估情况进行个性化健康管理。结果健康干预前后患者的自我护理能力,糖尿病知识知晓率及总评分,糖尿病代谢自控指标、生活满意度均有明显提高(P0.01)。结论健康干预的实施能有效改善被管理人员的整体健康状况和生活质量。     

分析社区护理干预对2型糖尿病患者的健康行为的影响

目的研讨分析社区护理干预对2型糖尿病患者的健康行为的影响。方法随机抽取2012年11月—2015年11月2型糖尿病患者共计80例,将其随机分成两组,分别是观察组与对照组,每组40例,其中对照组采用常规护理进行治疗;观察组采用社区护理干预。比较两组患者的遵医率情况、疾病了解程度以及血糖控制情况。结果观察组在按时检查、饮食控制、运动治疗以及自我监测四方面均优于对照组(P0.05);药物治疗方面比较,差异无统计学意义(P0.05);疾病知识了解情况比较观察组优于对照组(P0.05);两组在出院时其空腹血糖及餐后2h血糖水平比较差异无统计学意义(P0.05);观察组在随访结束后其空腹血糖及餐后2h血糖水平低于对照组(P0.05)。结论社区护理干预对2型糖尿病患者临床效果的影响显著,值得临床推广。     

社区护理干预在2型糖尿病患者中的应用效果

目的探讨社区护理干预在2型糖尿病患者中的应用效果。方法选取2018年2月—2019年2月期间的76例2型糖尿病患者作为研究对象。以护理干预模式的不同为根据进行分组,将76例患者分为2组,各38例。采取常规护理干预的38例患者为对照组,采取社区护理干预的38例患者为研究组。观察并比较2组的护理效果。结果随访6个月,研究组的空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平明显低于对照组;研究组的总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论社区护理干预在2型糖尿病患者中有着良好的应用效果,值得推广。     

综合干预模式对2型糖尿病病人抑郁治疗效果的观察

目的探讨综合干预模式（糖尿病教育、心理干预、适量抗抑郁药物）对糖尿病伴发抑郁症状的影响。方法在常规治疗前提下，应用抑郁自评量表（SDS）和生活事件量表（LES）测评，观察分析干预治疗前后病人抑郁状态、抑郁水平及血糖水平指标的变化。结果8例抑郁症状明显病人的SDS总分、空腹血糖及餐后2h血糖明显改善（P〈0．01），SDS单项指标中，有5项改善明显（P〈0．05）。结论2型糖尿病伴抑郁症状病人采用“综合干预模式”参与辅助治疗可改善抑郁症状及糖代谢。     

社区综合护理干预对社区2型糖尿病患者糖脂代谢水平的影响研究

对哈尔滨市第一医院所管辖社区的糖尿病患者中,抽取了150例2型糖尿病患者,进行综合护理干预6个月后,比较护理干预前后糖尿病患者的空腹血糖,餐后2h血糖,胆固醇,甘油三脂,低密度脂蛋白等指标均较干预前明显降低,差异均有统计学意义(P0.05)。社区综合护理干预措施可以改善糖尿病患者糖脂代谢水平,临床疗效显著。     

家庭综合护理干预在2型糖尿病患者中的应用效果观察

目的探讨家庭综合护理干预在2型糖尿病患者中的干预措施及临床效果。方法选择自2012年6月—2014年6月该院收治的162例2型糖尿病患者,随机分成干预组和对照组。每组81例。对照组实施内科常规护理,实验组采取以家庭为中心集体参与的家庭综合护理干预模式。6个月后比较两组空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)的变化情况。结果实验组患者FPG、2h PG、Hb A1c、TC均低于对照组。两组相比差异有统计学意义(P<0.05)。结论以家庭为中心集体参与的综合护理干预模式可以提高患者的自我护理行为,促进病人采取健康的生活用品方式,减慢并发症进程,提高患者的生活质量。     

社区干预对2型糖尿病控制的影响

目的 研究社区干预效果对2型糖尿病控制的影响.方法 随机选取该中心的两个居委,分别作为干预组和对照组,体检筛查出符合国际糖尿病诊断标准的2型糖尿病患者作为研究对象进行研究,干预组60例,对照组经52例.两组患者基本情况均无统计学差异.对照组仅进行疾病的常规药物治疗;干预组除给予相关治疗外,还给与相关的社区干预.随访干预1年后,测定患者空腹血糖(FPG)、餐后2h血糖(2 h PG),糖化血红蛋白(HbAlc)、血浆总胆固醇(TC)、甘油三酯(TG)的水平,进行对比分析.结果 干预组干预前后,与对照组于预后比较FPG、2 hPG、HbAlc,血浆TC,TG含量均下降,差异有显著性(P＜0.05).结论 对2型糖尿病患者进行社区干预,可以有效延缓糖尿病的控制.     

社区护理干预对2型糖尿病患者生活质量的影响

目的：研究探讨社区护理干预对2型糖尿病患者生活质量的影响。方法选取2011年1月-2013年10月期间收治的65例2型糖尿病患者作为研究组对象,采用社区护理干预,同时选取65例未进行社区护理干预的2型糖尿病患者作为对照组,比较两组患者的疾病控制情况。结果在出院时两组患者的空腹血糖和糖化血红蛋白水平差异无统计学意义（P＞0.05）,护理干预后,研究组患者的空腹血糖为（7.57＆#177;2.29）mmol/L,糖化血红蛋白为（5.43＆#177;1.71）%,明显低于对照组。结论对2型糖尿病患者进行社区护理干预服务,可以增强患者对于疾病知识的了解,改善患者的心理状态,对于血糖控制和生活质量的提高具有积极的意义。     

社区护理干预对2型糖尿病患者生活质量的影响

目的研究探讨社区护理干预对2型糖尿病患者生活质量的影响。方法选取2011年1月—2013年10月期间收治的65例2型糖尿病患者作为研究组对象,采用社区护理干预,同时选取65例未进行社区护理干预的2型糖尿病患者作为对照组,比较两组患者的疾病控制情况。结果在出院时两组患者的空腹血糖和糖化血红蛋白水平差异无统计学意义(P>0.05),护理干预后,研究组患者的空腹血糖为(7.57±2.29)mmol/L,糖化血红蛋白为(5.43±1.71)%,明显低于对照组。结论对2型糖尿病患者进行社区护理干预服务,可以增强患者对于疾病知识的了解,改善患者的心理状态,对于血糖控制和生活质量的提高具有积极的意义。     

Effect of community management of diabetes mellitus on patients with type 2 diabetes mellitus concomitant with depression

The objective of the study was to explore the effect of management of type 2 diabetes mellitus (T2DM) concomitant with depression in a community setting. Ninety-one cases of patients with T2DM concomitant with depression were selected as study subjects and were randomly divided into two groups, 45 cases as the control group treated with comprehensive treatment for diabetes and 46 cases as the observation group received management of T2DM concomitant with depression besides the above treatments the control group received. After 3 months, body mass index (BMI), fasting plasma glucose (FPG), postprandial two-hour plasma glucose (2hPG), glycosylated hemoglobin (HbA1c), and Hamilton depression scale (HAMD scoring) were compared between the two groups. While BMI in the observation group had no significant difference compared with the control group, FPG, 2hPG, HbA1c, and HAMD scoring in the observation group were significantly higher than those in the control group (P<0.05). Standardized management of T2DM concomitant with depression in a community setting can improve the treatment effect for patients with T2DM concomitant with depression.     

Effect of supervised integrated exercise on heart rate variability in type 2 diabetes mellitus

BACKGROUND: Heart rate variability (HRV) reflects autonomic nervous system modulation of cardiac activity. There is a relationship between degrees of physical activity, HRV changes and the risk of cardiovascular disease. AIM: To study the effect of a supervised integrated exercise programme on HRV in type 2 diabetes mellitus (DM). METHODS: The study group consisted of 48 patients (27 males, mean age 62+/-7 years) with type 2 diabetes, of whom 28 underwent a special exercise programme whereas the remaining 20 did not and served as the control group. The supervised integrated exercise programme was applied for a period of 9 months. Deep breathing time domain HRV (difference between the shortest and the longest R-R interval over one minute) was measured at baseline and after 3, 6 and 9 months. RESULTS: A significant improvement in the HRV values was observed with increasing duration of exercise (13.03+/-1.08 beats/min at baseline versus 16.5+/-1.11 beats/min at 9 months, p <0.001) whereas HRV decreased in the control group (14.85+/-1.15 beats/min at baseline vs. 14.30+/-1.75 at 9 months, p <0.05). Favourable changes in HRV in the exercise group were gender-dependent and were significant in males (12.4+/-1.76 beats/min at baseline vs. 16.18+/-1.91 at 9 months, p <0.001) whereas in females only a trend towards HRV improvement was observed. The HRV changes were also age-dependent and were more pronounced in younger patients than in the elderly. The metabolic parameters of diabetes control (blood glucose and glycosylated haemoglobin levels) significantly improved in the exercise group and significantly worsened in the control group. CONCLUSIONS: Regular supervised integrated exercise significantly improves HRV in patients with type 2 DM, which may favourably influence their long-term prognosis.     

北京市东城区小黄庄社区老年糖尿病人群综合干预效果分析

目的 评价社区综合干预对老年2型糖尿病患者的控制效果,为社区慢性病干预提供建议.方法 对东城区小黄庄社区的102例老年糖尿病患者进行综合干预,为期1年,包括:健康教育、定期体检、饮食、运动和心理等综合干预.结果 干预后相关知识知晓,参与运动的人数均有显著改善,血压、血糖各项指标差别也有显著意义.结论 社区综合干预对糖尿病患者有较好的控制效果,社区卫生站应该开展积极、有效的综合干预.     

Nonpharmacological interventions for the prevention of type 2 diabetes mellitus

During the past decade, improved understanding of the pathophysiological mechanisms of diabetes development has resulted in advances in therapeutic concepts, but has also supported the potential for diabetes prevention through nonpharmacological means. At the beginning of the century, we experienced a shift in paradigm, as landmark studies have shown that diabetes mellitus is preventable with lifestyle intervention; moderate changes in diet and physical activity produce a substantial and sustained reduction in the incidence of type 2 diabetes mellitus (T2DM) for individuals with impaired glucose tolerance. This evidence must now be translated into clinical and public-health practice, but translational studies have varied in their ability to replicate the results of clinical trials. This variation reflects a number of challenging barriers for diabetes prevention in real-world clinical practice, which makes it necessary to focus on identifying efficient intervention methods and delivery mechanisms. Research is now focusing on these mechanisms, as well as on developing efficient screening and risk-identification strategies and realistic scenarios for public-health policy to implement diabetes prevention programs. In this Review, we will discuss these mechanisms and will consider the implications of diabetes prevention for public-health strategy and policy.     

2型糖尿病性骨质疏松骨质量改变研究

尽管糖尿病和骨质疏松症是两种不同的慢性代谢性疾病,但糖尿病患者由于血糖异常、胰岛素缺乏或不足、降糖药物应用等诸多因素,经常会影响骨量与骨质量,导致骨质疏松。因此,糖尿病性骨质疏松症(diabetic osteoporosis,DOP)已经被认定为糖尿病的慢性并发症之一。我国2型糖尿病患者众多,影响较之1型糖尿病更为广泛。多项临床研究显示,2型糖尿病性骨质疏松症、骨折风险增高的原因并非是骨密度的减少,而是多种原因导致的骨质量改变,主要包括骨结构与骨质材料属性等。本文就近年来2型糖尿病性骨质疏松骨质量改变相关的研究进展进行综述。     

2型糖尿病对左室功能的影响

目的:探讨2型糖尿病(DM)对心脏左室功能的影响。方法:选取行冠状动脉造影及左室造影中冠状动脉造影阴性患者193例作为研究对象,按是否患2型DM分为DM组(93例)和对照组(100例)。对比2组左室造影所测左室射血分数(LVEF)、左室舒张末容积指数(LVEDVI)、左室舒张末压(LVEDP)及心脏彩超测得心脏各参数间的差异,并进行统计学分析。结果:2组间LVEF、LVEDVI、左室直径、右房直径、右室直径差异无统计学意义(P>0.05),而DM组LVEDP高于对照组[(9.4±2.6)∶(7.9±2.0)mmHg(1 mmHg=0.133kPa)],P<0.01;DM组左房直径较对照组增大[(37.1±6.3)∶(34.6±0.6)mm],P<0.01;E/A比值较对照组降低(1.0±0.3∶1.1±0.3),P<0.05。结论:2型DM可降低患者的左室舒张功能。     

Effect of gender on treatment outcomes in type 2 diabetes mellitus

Aim

To evaluate the effect of gender on clinical outcomes in people with type 2 diabetes mellitus (T2DM) receiving antidiabetes therapy.

Methods

This is a pooled analysis from nine similarly designed phase 3 and 4 randomized, controlled studies evaluating insulin glargine and an active comparator (NPH insulin, insulin lispro, premixed insulin, oral antidiabetes drugs, dietary intervention) in adults with T2DM. Impact of gender on outcomes including HbA1c, fasting plasma glucose (FPG), weight-adjusted insulin dose, and hypoglycemia incidence was evaluated after 24 weeks of treatment.

Results

Overall, 1651 male and 1287 female individuals were included; 49.8% and 50.2% were treated with insulin glargine or comparators, respectively. Females receiving insulin glargine were less likely than males to achieve a glycemic target of HbA1c ≤ 7.0% (53 mmol/mol) (54.3% vs 60.8%, respectively, p = 0.0162); there was no difference between females and males receiving comparators (52.7% vs 51.3%, respectively, p = 0.4625). Females had significantly greater reductions in FPG (3.1 mg/dL, p = 0.0458), required significantly higher insulin doses (0.03 IU/kg, p = 0.0071), and had significantly higher annual rates of symptomatic (p < 0.0001), glucose-confirmed (<50 and <70 mg/dL) symptomatic (p = 0.0005 and p < 0.0001), and severe hypoglycemia (p = 0.0020) than males.

Conclusions

Females in this analysis had smaller reductions in HbA1c and were less likely to reach glycemic goals despite higher insulin doses and more hypoglycemic events than males. Differences in gender responses to therapy should be considered when individualizing treatment for people with T2DM.     

个性化综合饮食治疗在2型糖尿病患者中的应用

目的分析个性化综合饮食治疗对2型糖尿病患者的治疗效果。方法 102例2型糖尿病患者随机分为治疗组和对照组,每组51例。其中,对照组给予常规治疗,治疗组给予个性化综合饮食治疗。比较两组临床治疗效果及血糖各项指标变化,观察有无不良反应。结果治疗组治疗总有效率显著高于对照组(P0.05);血糖各项生理指标明显低于对照组(P0.05)。两组均无不良反应发生。结论个性化综合饮食治疗可显著降低2型糖尿病患者血糖,提高治愈效果,病情控制较好。     

老年2型糖尿病患者社区综合干预效果评价

目的探讨社区综合干预对老年2型糖尿病患者的治疗效果。方法纳入新发老年2型糖尿病患者（诊断时间＜9个月）242例,随机分为对照组（n=121）和干预组（n=121）。对照组接受常规降糖治疗和血糖监测,干预组在对照组基础上实施运动干预、饮食干预和心理干预。9个月后比较两组体质指数（BMI）、空腹血糖（FBG）、血压、血脂等变化。结果干预组血糖控制达标的比例高于对照组（84.3%vs.71.9%,P=0.017）。对照组干预后FBG水平较治疗前有所下降,其他指标与干预前比较均无统计学差异（P＜0.05）;干预组干预后BMI[（22.18±6.30）kg/m2 vs.（24.34±5.76）kg/m2]、FBG[（6.14±1.40）mmol/L vs.（6.75±1.80）mmol/L]、收缩压[（141.25±19.73）mmHg vs.（147.05±21.55）mmHg]及总胆固醇[（1.71±0.69）mmol/L vs.（1.82±0.78）mmol/L]、甘油三酯[（1.69±0.72）mmol/L vs.（1.78±0.91）mmol/L]、低密度脂蛋白水平[（2.82±0.75）mmol/L vs.（2.91±0.92）mmol/L）]均显著低于干预前,差异有统计学意义（P＜0.05）。结论社区综合干预可提高血糖控制效果,有效改善老年2型糖尿病患者的血糖、血压和血脂水平,值得在社区慢病管理中推广。     

不同干预措施对老年2型糖尿病患者脑血管储备能力的影响

目的探讨不同干预措施对老年2型糖尿病患者脑血管储备(CVR)能力的影响。 方法选取老年2型糖尿病患者60例及正常健康体检老年自愿者60例(对照组)。糖尿病组根据治疗方法不同分为康复锻炼组、丁苯酞治疗组、盐酸氟桂利嗪治疗组,每组20例,治疗时间均为6个月。对所有受试者利用经颅多普勒超声结合屏气试验评估颅内血管反应,计算屏气指数(BHI)对CVR进行评价。各组患者治疗前后BHI的比较采用配对t检验。 结果糖尿病患者治疗前BHI为0.49±0.08,对照组BHI为0.55±0.05,差异有统计学意义(t＝－5.49,P<0.01)。治疗后,康复锻炼组和盐酸氟桂利嗪治疗组BHI均无明显变化,与治疗前比较差异无统计学意义(0.50±0.08、0.56±0.09,0.49±0.07、0.53±0.08;t＝－1.38、－1.34,P>0.05);而丁苯酞治疗组BHI明显增高,与治疗前比较差异有统计学意义(0.54±0.07,0.50±0.08;t＝1.72,P＝0.01)。 结论老年2型糖尿病患者的CVR较正常老年人下降,给予丁苯酞治疗可以适当改善老年2型糖尿病患者的脑血管储备能力。