惠州市精神分裂症人群中2型糖尿病患者健康管理效果分析

目的 了解广东省惠州市纳入国家基本公共卫生服务管理的精神分裂症（SCHIZ）合并2型糖尿病（T2DM）患者现况,评价共病患者管理效果,为该人群的T2DM防治提供参考依据。方法 2020年3—5月收集辖区35岁及以上在管SCHIZ患者健康档案信息并开展问卷调查,对SCHIZ合并T2DM患者分为已管理组（纳入T2DM管理）和未管理组（未纳入T2DM管理）,SCHIZ患者及T2DM共病患者的人口学特征、重点慢性病及其危险因素和T2DM共病患者血糖控制效果。结果 SCHIZ患者中T2DM的患病率为22.3%;管理组高血压患病率（χ²=7.397）、T2DM患者知晓率（χ2=7.397）、T2DM患者知晓率（χ²=98.694）、血糖控制率（χ2=98.694）、血糖控制率（χ²=114.004）、健康知识关注度（χ2=114.004）、健康知识关注度（χ²=26.071）均高于未管理组,差异有统计学意义（P<0.01）;口味较未管理组轻,差异有统计学意义（χ2=26.071）均高于未管理组,差异有统计学意义（P<0.01）;口味较未管理组轻,差异有统计学意义（χ²=8.018,P<0.05）。结论 惠州地区SCHIZ患者中T2DM的患病率较高,共病患者血糖管理更为困难;该地区开展国家基本公共卫生慢性病管理服务具有一定成效,但在行为改变方面效果不明显;应注重共病患者协同管理作用,有针对性地提供健康指导,促进健康行为的改变。     

精神分裂症合并2型糖尿病患者颈动脉斑块相关因素分析

目的探讨长期住院精神病合并糖尿病患者颈动脉斑块的相关危险因素、方法选取北郊医院精神病区住院的精神病合并糖尿病患者70例,同时选取不合并糖尿病的精神病患者71例作为对照组。测定总胆固醇(TC)、总胆红素、空腹血糖、空腹C肽、糖化血红蛋白等指标,一般资料包括性别、年龄,并记录同期体质量和身高计算体质量指数(BMI),同时行彩色多普勒颈动脉超声检查,采用Logistic回归分析的方法,以是否存存斑块作为因变量,以总胆固醇、BMI、年龄、性别等指标作为自变量进行分析。结果在糖尿病组中,性别、年龄、BMI、TC是对颈动脉斑块有预测意义的危险因素。在对照组中,有预测意义的因素为性别、年龄和BMI。结论对长期住院的精神病合并糖尿病患者进行有效的体质量和血脂水平控制可能有利于防止动脉硬化及其并发症。     

慢性精神分裂症共患2型糖尿病患者的降糖治疗

目的探究慢性精神分类症合并2型糖尿病患者的降糖治疗效果。方法从该院2018年1月-2019年1月期间收治的慢性精神分类合并2型糖尿病患者中选取72例作为该次研究实验对象,随机降低分为对照组和观察组,对照组采用胰岛素治疗,观察组给予药物+胰岛素治疗,比较两组治疗效果。结果观察组空腹血糖水平、餐后2 h血糖水平以及糖化血红蛋白均优于对照组,胰岛素平均用量较对照组低,生活质量较对照组高,差异有统计学意义(P<0.05)。结论对精神分裂合并2型糖尿病患者实施降糖治疗,能够改善患者糖代谢指标,降低胰岛素使用量,提高患者糖尿病自我管理水平,治疗效果显著。     

新诊断2型糖尿病和糖尿病前期人群中糖尿病视网膜病变患病率及危险因素分析

目的了解新诊断2型糖尿病（T2DM）和糖尿病（DM）前期人群中视网膜病变的患病情况及影响因素,为是否需要对他们进行早期常规眼底检查和干预提供理论依据。方法问卷调查400名新诊断DM和DM前期患者的血糖资料,并用免散瞳眼底照相行眼底筛查,计算糖尿病视网膜病变（DR）患病率。结果共发现16例非增生型DR。DR患病率在新诊断的DM、IGT、IFG中分别为5.4%、3.7%、6.9%,糖耐量正常者中未发现DR。结论新诊断T2DM和DM前期人群中DR患病率较低,对其行早期常规眼底筛查的临床意义有待论证。     

2型糖尿病与精神分裂症共病患者的自我管理障碍与促成因素分析

目的分析单纯2型糖尿病(A组)、有并发症2型糖尿病(B组)及2型糖尿病与精神分裂症共病患者(C组)3组间的糖尿病自我管理障碍与促成因素,了解不同患者的自我管理效能。方法收集2019年10月—2020年4月335例目标人群进行问卷调查;运用因子分析法降维提取公因子,命名及解释其现实意义;借鉴Likert评分法,比较各组间总得分、各公因子的得分差异。结果大部分受访者对题目观点的认可度较高,平均同意比例达73.0%,但在“管理我的糖尿病比管理我的心理健康更重要”(18.6%)、“控制糖尿病需要特殊技能”(31.4%)、“我的精防医生帮助我管理好我的糖尿病”(57.7%)方面认可度较低。将27个变量降维后,共提取6个公因子,累积解释方差达到70.019%,分别是管理糖尿病正向信念(F1)、管理糖尿病的社会及医学支持(F2)、管理糖尿病的能力(F3)、管理糖尿病负向信念(F4)、如果未管理好糖尿病的健康态度(F5)、管理糖尿病的心理健康需求(F6)。A组的总得分、F1、F4、F5得分高于其他两组,差异有统计学意义(P<0.001),A组F2得分低于B组;C组的F2、F3、F4和F5得分均低于其他两组,差异有统计学意义(P<0.001),在F6的得分最高。结论有并发症2型糖尿病患者特别是2型糖尿病与精神分裂症共病患者实施糖尿病自我管理的障碍较大,2型糖尿病与精神分裂症共病患者对心理健康的需求更大;开展糖尿病自我管理应针对性解决不同人群特别是共病患者人群的自我管理障碍因素,予以更广泛的社会及医学关注,提高其自我管理效能。     

北京地区2型糖尿病患者糖尿病心脏自主神经病变现况调查

目的:调查北京地区2型糖尿病（T2DM）心脏自主神经病变（CAN）的患病率,探讨CAN的临床特点和发病危险因素。方法:本研究为多中心随机横断面研究。对2015年10月至2016年4月在北京市城区和郊区13家医院门诊就诊的T2DM患者,采用随机抽样的方法进行问卷调查、体格检查及实验室检查。根据心脏自主神经功能试验结果将患...     

青少年2型糖尿病

近年成人2型糖尿病(T2DM)患病率在迅速增加，更严重的是最近报告青少年T2DM也在不断增加。现就青少年T2DM的进展作一综述。     

利培酮联合二甲双胍治疗精神分裂症合并2型糖尿病患者的效果观察

2019年2月至2020年3月选120例精神分裂症合并T2DM患者随机平分成对照组采用利培酮治疗,实验组则联合利培酮与二甲双胍.结果:对照组治疗后的HbA1c、FPG水平均高于治疗前(P<0.05);而实验组治疗后的HbA1c、FPG水平则明显低于治疗前(P <0.05);实验组治疗后的HbA1c、FPG水平均低于对照...     

2型糖尿病患者抑郁的患病率及其危险因素

目的　调查 2型糖尿病患者抑郁的患病率 ,分析与抑郁相关的危险因素。　方法　 2 2 2例2型糖尿病患者 ,男 115例 ,女 10 7例 ,年龄 ( 5 6± 13)岁 ,病程 ( 7± 6 )年 ,用Zung抑郁自量表进行抑郁评分 ,抑郁指数≥ 0 .5者诊断为抑郁。同时采集身高、体重、体重指数 (BMI)、病程、临床代谢指标、与糖尿病 (DM)有关的健康指标 (如吸烟史、DM家族史等 )。计算抑郁的患病率 ,用非条件Logistic回归筛选抑郁的危险因素。　结果　 2 2 2例 2型糖尿病患者中患抑郁者 5 8例。选入Logistic回归方程的变量有 :性别、年龄、民族、婚姻状态、DM家族史、病程、BMI、收缩压、舒张压、空腹血糖、餐后 2h血糖、糖化血红蛋白(HbA1c)、甘油三酯 (TG)、胆固醇 (CH)、高密度脂蛋白 胆固醇 (HDL C)、低密度脂蛋白 胆固醇和并发症数目。进入单因素非条件Logistic回归方程的有 :性别、病程、TG、CH、HbA1c和并发症的数目。进入多因素非条件Logistic回归方程的有病程、性别、HbA1c和并发症的数目。　结论　 2型糖尿病抑郁的患病率为2 6 .1% ,性别、病程、HbA1c和并发症的数目是 2型糖尿病合并抑郁的独立危险因素 ,TG和CH是次要危险因素     

中医体质辨识在2型糖尿病患者健康管理中应用效果研究

目的 分析在2型糖尿病患者的健康管理中应用中医体质辨识对患者的应用效果.方法 在该院2019年1月-2020年12月收治的2型糖尿病患者中抽取98例作为研究对象,用数字抽签法将98例研究对象分为研究组与参照组,每组49例,参照组患者采用健康管理进行干预,研究组患者在此基础上应用中医体质辨识,观察两组干预前后的空腹血糖水...     

上海市中心城区已诊断2型糖尿病患者的治疗达标现况分析

目的 评价上海市中心城区30岁以上已诊断2型糖尿病者血糖、血压及血脂等指标的控制情况.方法 整群抽样选中上海中心城区30岁以上已诊断2型糖尿病者1039例.测量身高、体重、腰围、臀围、血压,留取空腹血样,测定血糖、血脂、肾功能.依据中华糖尿病学会(CDS)对糖尿病者的治疗建议分析上海市中心城区30岁以上已诊断2型糖尿病者的血压、血糖和血脂控制情况.结果 (1)空腹血糖控制在理想范围的比例为18.1%,HbAIc＜6.5%比例为38.1%.(2)收缩压＜130 mmHg的比例为24.7%,舒张压＜80 mmHg的比例为29.5%,血压＜130/80 mmHg的比例为15.0%.(3)总胆固醇＜4.5 mmol/L的比例为21.6%;甘油三酯＜1.5 mmol/L的比例为44.7%;低密度脂蛋白＜2.5 mmol/L的比例为24.7%;高密度脂蛋白＞1.1 mmol/L的比例为61.6%.(4)将HbAlc＜6.5%,血压＜130/80 mmHg及低密度脂蛋白＜2.6 mmol/L定义为全面达标,全面达标率仅为2.71%.结论 上海市中心城区30岁以上已诊断2型糖尿病者的全面达标率仅为2.71%,有必要进一步严格社区糖尿病者的治疗.     

Inpatient management of hospitalized patients with type 2 diabetes

Over the past 4 years, the scientific literature addressing issues relevant to inpatient hyperglycemia and its management has grown dramatically but remains incomplete. The growing interest in inpatient diabetes management is particularly pertinent given the epidemic rise in the prevalence of type 2 diabetes and the associated increase in the proportion of inpatients carrying this diagnosis. The benefits of aggressive glucose control are well-established in certain admission categories. These benefits likely apply to many other admission diagnoses, but remain unproven at this time. Similarly, the best methods of glucose control remain uncertain in the various inpatient settings. Intensive insulin infusion therapy is becoming the standard care in the intensive care unit setting. Its use is also growing in less acute inpatient settings but requires further study. Inpatient subcutaneous insulin recommendations are general based on experience gained in the outpatient setting but offer a practical, physiologic approach.     

The effects of popular diets on type 2 diabetes management

Type 2 diabetes can be managed with the use of diabetes self‐management skills. Diet and exercise are essential segments of the lifestyle changes necessary for diabetes management. However, diet recommendations can be complicated in a world full of different diets. This review aims to evaluate the evidence on the effects of three popular diets geared towards diabetes management: low‐carbohydrate and ketogenic diet, vegan diet, and the Mediterranean diet. While all three diets have been shown to assist in improving glycaemic control and weight loss, patient adherence, acceptability, and long‐term manageability play essential roles in the efficacy of each diet.     

Pharmacological management of type 2 diabetes mellitus in patients with CKD

Effective and appropriate control of blood glucose can significantly reduce the risk of diabetic complications and all-cause mortality in patients with diabetes mellitus and recent years have seen a number of new anti-diabetic medications marketed. However, approximately 30% of patients with diabetes mellitus develop progressive chronic kidney disease (CKD) limiting the selection of agents that can safely be used. Whilst older agents such as metformin and the sulphonylureas remain the mainstay of initial treatment, the elimination and adverse effects profile of a number of these drugs can be a concern in patients with CKD. Additionally, use of the newer agents is often limited by a lack of long-term safety data, particularly in this patient group. Treatment guidelines for anti-diabetic therapy rarely consider safe and efficacious management of those patients with CKD.     

2型糖尿病血脂异常的处理

2型糖尿病患者心血管疾病风险显著增加,治疗血脂异常可以降低心血管事件发生危险.本文介绍了糖尿病调脂治疗的临床证据、调脂治疗目标,并对临床如何选择调脂治疗药物进行综述.     

Assessment and management of hypertension in patients with type 2 diabetes

Background: Hypertension is a major risk factor for adverse outcomes in type 2 diabetes and an important target for intervention. Despite this, the management of blood pressure (BP) remains suboptimal, particularly in patients at increased risk for cardiovascular and chronic kidney disease. The aim of this study was to estimate the frequency of hypertension and its management in consecutive clinic‐based samples of patients with type 2 diabetes in Australian primary care. Methods: BP levels and antihypertensive management strategies were compared in patients with type 2 diabetes recruited as part of the Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes (DEMAND) study in 2003 (n = 1831) and the National Evaluation of the Frequency of Renal impairment cO‐existing with Non‐insulin‐dependent diabetes (NEFRON) study in 2005 (n = 3893). Systolic BP levels and the use of antihypertensive therapies were examined in patients with and without chronic kidney disease. Results: The patient characteristics in both studies were similar in that more than 80% of patients in both studies were hypertensive. Systolic BP targets of ≤130 mmHg were achieved in approximately half of all treated patients in both studies. However, the use of antihypertensive therapy either alone or in combination increased from 70.4% in DEMAND to 79.5% in NEFRON 2 years later (P < 0.001). Despite this, antihypertensive therapy continued to be underutilized in high‐risk groups, including in those with established chronic kidney disease. Conclusion: The DEMAND and NEFRON studies both show that BP control is achievable in Australian general practice, with more than half of all patients seeing their general practitioners achieving a target systolic BP ≤130 mmHg. However, more needs to be done to further reduce BP levels, particularly in patients at high risk of adverse outcomes.     

Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center

Technology and improved care coordination models can help diabetes educators and providers meet national care standards and provide culturally sensitive diabetes education that may improve diabetes outcomes. The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program (Comprehensive Diabetes Management Program, CDMP) for poorly controlled Hispanic type 2 diabetes (T2DM) patients in an urban community health center setting. Patients were randomized to the intervention condition (IC; n = 21) or an attention control condition (AC; n = 18). IC and AC conditions were compared on rates of adherence to national clinical practice guidelines (blood glucose, blood pressure, foot exam, eye exam), and levels of diabetes distress, depression, and treatment satisfaction. IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC (-1.6% ± 1.4% versus -0.6% ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC = 28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%), and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression. The CDMP intervention was more effective than an attention control condition in helping patients meet evidence-based guidelines for diabetes care.     

Non-pharmacological management of type 2 diabetes

Major studies have demonstrated an association between poor glycaemic control and the development of micro - and macrovascular complications in type 2 diabetes. Optimized metabolic control, including treatment of hyperglycaemia and other risk factors, reduces the risk of complications. Current strategies aiming at achieving the best possible control include a non-pharmacological approach consisting of lifestyle intervention using physical exercise and modification of nutrition intakes in the early stage of type 2 diabetes, or in later stages, combined with pharmacotherapy. Such an approach is also efficient in preventing type 2 diabetes in patients with impaired glucose tolerance. The purpose of this review is to analyse, in a clinical practice perspective, the current recommendations with respect to lifestyle modifications.