Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting

OBJECTIVE: We conducted a retrospective study to evaluate the adequacy of glycemic, lipid, and blood pressure (BP) management for diabetic patients in a managed care organization (MCO). RESEARCH DESIGN AND METHODS: Patients aged > or =18 years with diabetes (n=7,114) were retrospectively identified over a 2-year period from the MCO's administrative database based on the Health Plan Employer Data and Information Set 2000 selection criteria using pharmacy, laboratory, and encounter data. Analyses examined demographics and percentages of patients tested and meeting American Diabetes Association goals for HbA1c, lipids, and BP, both overall and for those receiving medication treatment versus no treatment. RESULTS: Testing rates for A1C, LDL cholesterol, and BP were 77, 54, and 95%, respectively. The percentage of patients tested who were at goal were 37% for A1C, 23% for LDL cholesterol, and 41% for systolic BP. Of the patients in our sample, 72% were treated for glycemic control, 64% were treated for BP control, and only 28% were treated for lipid control. Of the patients who received medication treatment, less than one-third were at goal for A1C (29%) and LDL cholesterol (32%), whereas 40% were at goal for systolic BP. CONCLUSIONS: We found that although a large percentage of diabetic patients were tested for A1C, LDL cholesterol, and systolic BP, a much smaller percentage had reached their respective goals. More aggressive glycemic, lipid, and BP management appears to be needed to improve care for these patients.     

瑞舒伐他汀对高血压患者血糖、血脂及超敏C反应蛋白水平的影响

目的探讨瑞舒伐他汀对高血压患者血糖、血脂及超敏C反应蛋白(hs-CRP)水平的影响。方法选择86例不伴有糖尿病的高血压患者,采用自身对照方法,在常规降压治疗的基础上加服瑞舒伐他汀。观察用药前及用药8周后空腹血糖(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及hs-CRP的变化。结果本组患者治疗后TC、LDL-C及hs-CRP水平均较治疗前显著下降,而HDL-C水平却显著升高,治疗前后比较差异均有统计学意义(P<0.05或P<0.01);本组患者治疗后FBG及HbA1c水平较治疗前略有所上升,但治疗前后比较差异无统计学意义(P>0.05)。结论对高血压合并高脂血症及高hs-CRP水平者加用瑞舒伐他汀,可显著降低TC、LDL-C及hs-CRP水平,升高HDL-C水平,降低心血管临床终点。     

Effect of APOE genotype on lipid levels in patients with coronary heart disease during a 3-week inpatient rehabilitation program

It has been suggested that the apolipoprotein E (APOE) genotype modifies the effect of dietary and pharmacological interventions for lowering lipid levels. We wanted to determine whether APOE genotyping information would be useful in making lipid-lowering treatment decisions in clinical practice. We included 981 patients with coronary heart disease (CHD) enrolled in an inpatient 3-week standardized rehabilitation program. Of these, 555 (57%) patients received continued statin therapy and 232 (24%) patients received newly initiated statin therapy. Dietary intervention was part of the program only for 194 (20%) patients. Total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) levels decreased in all the groups of patients during rehabilitation. The decreases were less pronounced among the APOE E2 carriers. However, the observed variation among the groups with respect to reduction of lipid levels was accounted for mainly by the initial lipid levels (30-47%) and only marginally on the APOE genotype (1%) . We therefore found no evidence that APOE genotyping will be useful in guiding dietary or pharmacological lipid-lowering treatment decisions.     

抗阻训练对老年2型糖尿病患者糖代谢、脂代谢等方面的影响

目的探讨抗阻训练对老年2型糖尿病患者血糖、血脂、糖化血红蛋白（HbAlC）、胰岛素水平、尿微量白蛋白的影响。方法60例老年2型糖尿病患者随机分为观察组和对照组,每组30例。2组实验前均进行饮食指导,实验期间常规用药不变。对照组保持日常生活习惯,观察组进行抗阻训练。观察2组患者治疗前后空腹血糖（FBG）、餐后2小时血糖（2hBG）、空腹胰岛素（Fins）、餐后2h胰岛素（2hlns）、血脂、HbAlC、尿微量白蛋白（MA）水平。结果观察组治疗后FBG、2hBG、HbAlc水平明显降低。观察组治疗后FBG、2hBG、HbAIc水平明显低于对照组。2组患者治疗后甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL—c）水平均明显降低;观察组治疗后TG、TC、LDL—C水平明显低于对照组。2组治疗后Fins、2hIns、MA水平均较治疗前明显降低。观察组治疗后Fins、MA水平均较对照组明显降低。结论抗阻训练在调控老年2型糖尿病患者糖代谢和脂代谢等方面具有明显作用。     

Hypertension management in patients with diabetes: the need for more aggressive therapy

OBJECTIVE: Clinical trials have demonstrated the importance of tight blood pressure control among patients with diabetes. However, little is known regarding the management of hypertension in patients with coexisting diabetes. To examine this issue, we addressed 1) whether hypertensive patients with coexisting diabetes are achieving lower levels of blood pressure than patients without diabetes, 2) whether there are differences in the intensity of antihypertensive medication therapy provided to patients with and without diabetes, and 3) whether diabetes management affects decisions to increase antihypertensive medication therapy. RESEARCH DESIGN AND METHODS: We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted. RESULTS: Of the 274 hypertensive patients with diabetes, 73% had a blood pressure > or =140/90 mmHg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes. CONCLUSIONS: There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes.     

维持性血液透析患者血压控制不良的相关因素调查

目的探讨维持性血液透析患者血压控制不良的相关因素,通过对维持性血液透析患者进行调查分析,针对影响因素采取干预措施。方法测量122例维持性血液透析患者血压,对血压控制不良患者进行回顾性分析,并分析可能影响血压控制不良的相关因素。结果维持性血液透析患者高血压病107例,发生率为87．70％,其中血压控制不良者61例,占高血压病患者的57％;经Logistic多因素回归分析,与维持性血液透析患者血压控制不良的相关因素有6个,分别是促红细胞生成素应用量、Kt／V、体重超过干体重的10％、干体重未达标、每周透析次数、是否遵医嘱服药等。结论针对维持性血液透析患者采取合适的干预措施,详细指导患者及家属有效控制血压的方法,使患者获得相关的医疗、护理及自我保健的知识,从而自觉积极地进行治疗和保健。     

社区护理对2型糖尿病老年患者治疗效果及治疗相关行为的影响

目的探讨社区护理干预对2型糖尿病老年患者治疗效果及相关治疗行为的影响。方法采用便利抽样法选取2014年3-12月上海市某社区卫生服务中心门诊的136例2型糖尿病患者为研究对象,进行6个月的社区护理干预,6个月后观察糖尿病患者糖化血红蛋白(hemoglobin A1c,HbA1c)、血压、血脂以及规律服药等相关治疗行为。结果实施护理干预6个月后,患者HbA1c与干预前相比有明显降低,差异有统计学意义(P0.05);2型糖尿病老年患者血糖控制好的比例由9.6%提高至27.2%,血糖控制一般的比例由30.9%提高至62.5%,规律用药等治疗相关行为方面的比率均高于干预前,差异均有统计学意义(均P0.01);此外,与干预前比较,干预后2型糖尿病老年患者收缩压、舒张压、平均动脉压、三酰甘油、胆固醇和低密度脂蛋白都降低,差异均有统计学意义(均P0.05)。结论社区护理可有效改善2型糖尿病老年患者治疗相关行为,控制糖尿病患者的血糖水平,提高治疗的效果,进而可改善其血脂代谢、降低血压,促进患者康复。     

Lack of management of cardiovascular risk factors in type 2 diabetic patients

Effective management of diabetic patients includes comprehensive control for not only blood sugar, but also other cardiovascular risk factors. We assessed whether haemoglobin A1c (A1C) concentrations, blood pressure, low density lipoprotein (LDL) cholesterol levels and microalbuminuria were regularly measured in 281 patients with type 2 diabetes who received care for over 1 year in the Department of Family Medicine located in an urban area of Korea. Subsequently, in patients with A1C > 7%; blood pressure >130/80 mmHg; LDL cholesterol levels >100 mg/dl; or microalbuminuria, we evaluated the status of management for those cardiovascular risk factors. Physicians were most likely to measure A1C levels (98.6%), but less likely to measure microalbuminuria (56.2%), LDL cholesterol (73.7%), or blood pressure (74.4%). Patients whose A1C levels were above the goal (78.2%) were likely to receive optimal therapy. In contrast, only 21.1% of patients with uncontrolled blood pressure and 5.3% of patients with LDL cholesterol levels above the target range received optimal management. Of the 36 patients with microalbuminuria or overt proteinuria, 66.7% took angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Measurement of parameters indicating cardiovascular risk factors in type 2 diabetic patients was not optimal, particularly regular measurements for microalbuminuria and for controlling LDL-cholesterol and blood pressure. These findings indicate a need for greater education of comprehensive cardiovascular management in type 2 diabetic patients and their physicians.     

心肌梗塞患者长期应用美多心安随访结果

随访观察56例心肌梗塞患者长期服用美多心安对血脂、血糖和心功能的影响,服药6个月以上,每日100mg,平均砚察16.8±4.6个月。前后对比,结果表明心功能临床改善者占30.8％;收缩压、舒张压和心率较治疗前明显下降。彩色多普勒超声血流显象示心排血量(CO)和二尖瓣口E峰和A峰流速比值(VE/VA)无明显变化。36例血脂分析中,胆固醇(TC)水平较治疗前明显升高,其中男性29例TC亦明显升高,而女性7例三酸甘油酯升高,血糖无明显变化。     

Multicenter retrospective assessment of thiazolidinedione monotherapy and combination therapy in patients with type 2 diabetes: Comparative subgroup analyses of glycemic control and blood lipid levels

Background: Thiazolidinediones (TZDs) have contributed to the management of patients with type 2 diabetes mellitus as unique insulin-sensitizing agents. When used as monotherapy or in combination therapy, these drugs not only reduce glycosylated hemoglobin (HbA_1c) levels, but also effect changes in blood lipid concentrations and have the potential to ameliorate cardiovascular disease risk. Although drugs in the TZD class are perceived to be equivalent clinically, prospective and retrospective studies have demonstrated their ability to modify blood lipid levels.Objective: We evaluated and compared the effects of pioglitazone and rosiglitazone monotherapy and combination therapy on blood lipid levels and HbA_1c in patients with type 2 diabetes.Methods: We conducted a multicenter retrospective chart review of 1115 records of patients with type 2 diabetes who received pioglitazone or rosiglitazone, alone or in combination with other antidiabetic agents, between August 1, 1999, and August 31, 2000. The review was conducted to evaluate pretreatment and posttreatment levels of triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and HbA_1c.Results: All observed demographic characteristics, comorbidities, and concomitant drug use were similar in both treatment cohorts. Of the patients who received pioglitazone, 83% also received >_1 other antihyperglycemic agent and 59% received some form of antihyperlipidemic therapy. Among those who received rosiglitazone, 81% received concomitant antihyperglycemic medication and 60% received some form of antihyperlipidemic therapy. With pioglitazone, mean levels of serum triglyceride, total cholesterol, and LDL-C decreased and HDL-C increased in most patients, with or without concomitant antihyperglycemic medications; with rosiglitazone, with or without other antidiabetic agents, triglyceride and HDL-C levels decreased, whereas total cholesterol and LDL-C levels increased in most patients. Reductions in HbA_1c levels and increases in body weight related to each study drug were comparable.Conclusions: This comparative assessment of pioglitazone and rosiglitazone, based on observational data, reveals that use of these TZDs with other antidiabetic agents was similar in 605 primary care practices in the United States. In both monotherapy and combination treatment regimens, pioglitazone was associated with greater beneficial effects on lipids than was rosiglitazone. Additional studies are needed to determine the long-term outcomes of TZD therapy with concomitant antihyperglycemic medications.     

Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change

OBJECTIVE: To assess both standard and novel diabetes quality measures in a national sample of U.S. academic medical centers. RESEARCH DESIGN AND METHODS: This retrospective cohort study was conducted from 10 January 2000 to 10 January 2002. It involved 30 U.S. academic medical centers, which contributed data from 44 clinics (27 primary care clinics and 17 diabetes/endocrinology clinics). For 1,765 eligible adult patients with type 1 or type 2 diabetes with at least two clinic visits in the 24 months before 10 January 2002, including one visit in the 6 months before 10 January 2002, we assessed measurement and control of HbA(1c), blood pressure, and cholesterol and corresponding medical regimen changes at the most recent clinic visit. RESULTS: In this ethnically and economically diverse cohort, annual testing rates were very high (97.4% for HbA(1c), 96.6% for blood pressure, and 87.6% for total cholesterol). Fewer patients were at HbA(1c) goal (34.0% <7.0%) or blood pressure goal (33.0% <130/80 mmHg) than lipid goals (65.1% total cholesterol <200 mg/dl, 46.1% with LDL cholesterol <100 mg/dl). Only 10.0% of the cohort met recommended goals for all three risk factors. At the most recent clinic visit, 40.4% of patients with HbA(1c) concentrations above goal underwent adjustment of their corresponding regimens. Among untreated patients, few with elevated blood pressure (10.1% with blood pressure >130/80 mmHg) or elevated LDL cholesterol (5.6% with LDL >100 mg/dl) were started on corresponding therapy. Patients with type 2 diabetes were no less likely to be intensified than patients with type 1 diabetes. CONCLUSIONS: High rates of risk factor testing do not necessarily translate to effective metabolic control. Low rates of medication adjustment among patients with levels above goal suggest a specific and novel target for quality improvement measurement.     

Gender differences in secondary prevention of coronary heart disease: reasons to worry or not?

OBJECTIVE: To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. DESIGN: Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). SETTING: Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. SUBJECTS: A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n = 9135) and 12 months (n = 4802) of follow-up. The proportion of female patients (25%) did not differ between visits. MAIN OUTCOME MEASURES: Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. RESULTS: No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p < 0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. CONCLUSIONS: In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.     

A randomized,double-blind,controlled trial of vitamin C in the management of hypertension and lipids

The effect of vitamin C on blood pressure is not well established. This is a randomized, double-blind control trial. Eligible patients were followed for 8 months. Patients were randomized to 500, 1000, or 2000 mg vitamin C. During each visit, a history including medication change was obtained and standardized blood pressure measurements were performed. A 1-week dietary diary was filled out before each visit. Multiple regression analysis and subsequent multiple comparisons were used for data analysis. Fifty-four patients satisfied our criteria and agreed to participate. Thirty-one patients (mean age, 62 +/- 2 years; 52% men, 90% whites) were randomized to the three doses of vitamin C. Overall compliance was 48 +/- 2%. Both mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased during the vitamin C supplementation phase [mean SBP dropped by 4.5 +/- 1.8 mm Hg (P <.05) and DBP by 2.8 +/- 1.2 mm Hg (P <.05)]. There was no difference between the three vitamin C groups (P =.48). This effect was significant for only 1 month of supplementation, but the trend persisted. There was no reported intolerance to vitamin C. There was no change in lipid levels after 6 months of treatment. Vitamin C supplementation lowers blood pressure in mildly hypertensive patients. There is no additional benefit for a higher dose than 500 mg daily. The effect of vitamin C is most likely to be only short term.     

Effects of diet treatment on some biochemical and physiological parameters in patients with type 2 diabetes mellitus

The aim of the present study was to investigate the effect of diet treatment on serum glucose, triglyceride (TG), total cholesterol (TC), high density lipoprotein-(HDL) cholesterol, low density lipoprotein-(LDL) cholesterol and very low density lipoprotein-(VLDL) cholesterol levels, systolic and diastolic blood pressure and electrocardiograms (ECGs) in patients with type 2 diabetes mellitus (DM). Twenty healthy subjects (mean age 45.9 +/- 3.7 years) and newly diagnosed patients with type 2 diabetes prior to receiving diet treatment (mean age 47.6 +/- 6.2 years) were included in this study. Diabetic patients were given a standard dietary treatment that was composed of 50% to 55% carbonhydrate and 30% fat (1200 kcal for women and 1600 kcal for men) for 2 months. No diet treatment was applied for control. For both groups serum glucose, TG, TC, HDL-cholesterol, LDL-cholesterol and VLDL-cholesterol levels, systolic and diastolic blood pressure and ECGs were measured at the beginning and end of the diet treatment. Although diet treatment decreased the elevated serum glucose in diabetic patients, it still remained higher than that in the controls. Diet treatment also decreased the elevated TG and VLDL-cholesterol in diabetic patients to control values. Although heart rate and systolic blood pressure were higher, diastolic blood pressure was not different in diabetic patients than those in controls. Ventricular hypertrophy was also observed in ECGs of 10% of diabetic patients. Diet treatment normalized all of these findings, except systolic blood pressure. This study showed that diet treatment could not normalize the high systolic blood pressure in type 2 DM. Thus, an effective way of controlling blood pressure should be taken to improve healing in DM.     

2型糖尿病患者尿白蛋白排泄率与血脂的关系

目的探讨2型糖尿病患者尿白蛋白排泄率与血脂的关系。方法无尿路感染及原发性肾脏疾病病史的2型糖尿病患者68例,按尿白蛋白排泄率分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组。检测所有患者的空腹血糖、糖化血红蛋白、血清甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇。结果微量白蛋白尿组和大量白蛋白尿组空腹血糖、糖化血红蛋白、收缩压和舒张压均高于正常白蛋白尿组;大量白蛋白尿组的空腹血糖、糖化血红蛋白、收缩压和舒张压均较微量白蛋白尿组高。微量白蛋白尿组和大量白蛋白尿组血清甘油三酯、总胆固醇和低密度脂蛋白胆固醇水平均高于正常白蛋白尿组;大量白蛋白尿组血清甘油三酯、总胆固醇和低密度脂蛋白胆固醇较微量白蛋白尿组高。3组血清高密度脂蛋白胆固醇水平无统计学意义(P>0.05)。结论2型糖尿病患者尿白蛋白排泄率不仅与糖代谢指标和血压有关,与血脂也存在相关性,提示脂质代谢紊乱在糖尿病肾病的发生、发展中可能起一定的作用。     

Trends in lipid management among patients with coronary artery disease: has diabetes received the attention it deserves?

OBJECTIVE: To examine lipid management trends for coronary artery disease (CAD) patients with and without diabetes in order to determine whether those with diabetes are beginning to receive aggressive lipid management consistent with their elevated risk. RESEARCH DESIGN AND METHODS: We used outpatient medical record data from 47,813 CAD patients seen at 295 medical practices participating in the Quality Assurance Program II between 1996 and 1998. Lipid testing rates, lipid treatment rates, and serum lipid concentrations are described for CAD patients with and without diabetes within strata of office visit date. RESULTS: Lipid testing and treatment rates increased and mean lipid levels decreased markedly over time. Those with diabetes were 26% less likely to have a lipid profile and 17% less likely to receive a lipid-lowering medication than their nondiabetic counterparts, and this disparity did not diminish over time. Among treated patients, mean non-HDL cholesterol (non-HDL-C) and LDL cholesterol (LDL-C) declined less rapidly over time for patients with than without diabetes. CONCLUSIONS: Although impressive progress was made in the outpatient lipid management of CAD patients, lipid management for CAD patients with diabetes improved no more rapidly, and in some cases less rapidly, than for nondiabetic patients. Given their higher risk, more effort is needed to ensure that CAD patients with diabetes receive aggressive lipid management.     

Comparative analysis of plasma and erythrocyte 7-ketocholesterol as a marker for oxidative stress in patients with diabetes mellitus

OBJECTIVES: To reveal increased lipid peroxidation in diabetics by quantification of cholesterol oxidation products (COPs) not only in plasma, but also in erythrocytes. DESIGN AND METHODS: We quantified 7-ketocholesterol (7-kCho) by gas chromatography-mass spectrometry as a surrogate measure for COPs. These assays were performed on both plasma and erythrocytes in 20 control subjects and 20 treated patients with relatively poorly controlled Type 2 diabetes. RESULTS: Both plasma and erythrocyte 7-kCho levels in diabetics were significantly higher than those in control subjects. Although neither plasma nor erythrocyte 7-kCho levels were associated with markers for glucose tolerance in diabetics, a negative correlation of serum HDL-cholesterol levels with erythrocyte, but not plasma, 7-kCho levels was found. CONCLUSION: Increased oxidative stress in diabetics affects oxidation of cholesterol. Assays of COPs not only in plasma, but also in erythrocytes, may yield complementary information in lipid peroxidation.     

Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes

OBJECTIVE: Diabetes eliminates the protective effect of female sex on the risk of coronary heart disease (CHD). We assessed sex differences in the treatment of CHD risk factors among patients with diabetes. RESEARCH DESIGN AND METHODS: A cross-sectional analysis included 3,849 patients with diabetes treated in five academic internal medicine practices from 2000 to 2003. Outcomes were stratified by the presence of CHD and included adjusted odds ratios (AORs) that women (relative to men) were treated with hypoglycemic, antihypertensive, lipid-lowering medications or aspirin (if indicated) and AORs of reaching target HbA(1c), blood pressure, or lipid levels. RESULTS: Women were less likely than men to have HbA(1c) <7% (without CHD: AOR 0.84 [95% CI 0.75-0.95], P = 0.005; with CHD: 0.63 [0.53-0.75], P < 0.0001). Women without CHD were less likely than men to be treated with lipid-lowering medication (0.82 [0.71-0.96], P = 0.01) or, when treated, to have LDL cholesterol levels <100 mg/dl (0.75 [0.62-0.93], P = 0.004) and were less likely than men to be prescribed aspirin (0.63 [0.55-0.72], P < 0.0001). Women with diabetes and CHD were less likely than men to be prescribed aspirin (0.70 [0.60-0.83], P < 0.0001) or, when treated for hypertension or hyperlipidemia, were less likely to have blood pressure levels <130/80 mmHg (0.75 [0.69-0.82], P < 0.0001) or LDL cholesterol levels <100 mg/dl (0.80 [0.68-0.94], P = 0.006). CONCLUSIONS: Women with diabetes received less treatment for many modifiable CHD risk factors than diabetic men. More aggressive treatment of CHD risk factors in this population offers a specific target for improvement in diabetes care.     

食物GI与交换份用于2型糖尿病营养治疗观察

目的观察将食物血糖生成指数（GI）与食物交换份法（FE）结合运用于2型糖尿病患者的营养治疗后血糖血脂的变化以及患者对营养治疗的依从性，以寻求更好的糖尿病营养治疗方法。方法选取符合2型糖尿病诊断且合并血脂异常的住院患者80例，随机平均分为A、B两组。在临床药物治疗方案一致的基础上，A组运用食物GI与食物交换份法结合的方法，B组单纯运用食物交换份法。对患者进行营养治疗和营养教育，出院后通过门诊复诊、电话随访，继续强化对患者的营养治疗，观察血糖血脂的变化以及患者对营养治疗的依从性。结果经住院营养治疗，出院前复查两组空腹血糖（FBG）、餐后2h血糖（2hPBG）均有显著下降（P〈0．01），组间无显著差异（P〉0．05）。三个月后复查，与刚入院时比较，两组患者FBG、2hPBG显著下降（P〈0．01），糖化血红蛋白（HbA1C）、血清胆固醇（TC）、血清三酰甘油（TG）与刚入院时比较均有显著下降（P〈0．05），血清高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—c）无显著变化（P〉0．05），组间无显著差异（P〉0．05）。对营养治疗依从性较好的A组35例（88．0％）、B组24例（60．0％），两组有显著差异（P〈0．01）。结论食物GI与交换份法能很好地控制2型糖尿病患者的血糖血脂情况，患者对食物GI与交换份法比对单纯食物交换份法的依从性高。