家庭医生强化血糖监测对2型糖尿病患者血糖控制的效果评估

背景　我国糖尿病人群多，血糖达标率低，患者血糖监测意识薄弱，且目前对血糖监测与血糖控制关系的研究结论存在争议。目的　探讨家庭医生强化血糖监测对2型糖尿病患者血糖控制的效果，以期促进2型糖尿病患者血糖监测的合理化、规范化，进一步提高社区糖尿病管理水平。方法　选取2018年7-12月南翔镇社区卫生服务中心管理随访的血糖未达标的2型糖尿病患者120例为研究对象。应用计算机软件将患者随机分成两组，分别为监测组（60例）和对照组（60例）。对照组患者每3个月按其意愿自己在家或者来本中心检测1次血糖，持续6个月；监测组患者每周来家庭医生工作室检测1次血糖，家庭医生需及时做好血糖记录，收集患者提供的饮食与运动记录资料，并给予相应的指导，持续6个月。分别记录患者干预前及干预后3、6个月体质指数（BMI）、空腹血糖（FBG）、餐后2 h血糖（2 hPBG）、糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、总胆固醇（TC）。结果　干预方法与时间在BMI、HDL-C、TC上不存在交互作用（P>0.05），干预方法与时间在FBG、2 hPBG、HbA1c、LDL-C、TG上存在交互作用（P<0.05）；干预方法在BMI、HDL-C、TC上主效应不显著（P>0.05），干预方法在FBG、2 hPBG、HbA1c、LDL-C、TG上主效应显著（P<0.05）；时间在BMI、TC上主效应不显著（P>0.05），时间在FBG、2 hPBG、HbA1c、LDL-C、HDL-C、TG上主效应显著（P<0.05）。干预后6个月监测组FBG、2 hPBG、HbA1c、LDL-C、TG低于对照组（P<0.05）。监测组干预后6个月FBG、2 hPBG、HbA1c、LDL-C、TG低于本组干预前（P<0.05）。结论　家庭医生强化血糖监测有助于提高2型糖尿病患者的血糖控制效果，降低血脂水平，值得重视和推广。

Effect Evaluation of Intensive Blood Glucose Monitoring by Family Doctors on Blood Glucose Control in Type 2 Diabetes Mellitus

Background　In China，there are many people suffering from diabetes with poor awareness of blood sugar monitoring，and low rate of meeting glycemic targets.However，the relationship between blood glucose monitoring and control status is still controversial.Objective　To explore the effect of intensive blood glucose monitoring by family doctors on blood glucose control in patients with type 2 diabetes，to promote blood glucose monitoring in an appropriate and standardized way in such patients，and to further improve the level of community-based diabetes management.Methods　120 type 2 diabetes patients who received follow-up services from Nanxiang Town Community Health Center but failed to reach glycemic targets were enrolled from July to December 2018，and were equally randomized into monitoring group and control group by using computer software.Both groups received a 6-month intervention，during which the control group underwent blood glucose monitoring once every 3 months at home or at Nanxiang Town Community Health Center according to their own choice，and the monitoring group monitored blood glucose at the family doctors studio once a week，and the results were recorded by family doctors.Moreover，diet and exercise status and corresponding guidance of both groups during the intervention were collected.The intervention results were evaluated by BMI，fasting blood glucose（FBG），2-hour postprandial glucose（2 hPBG），glycosylated hemoglobin（HbA1c），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），triglyceride（TG）and total cholesterol（TC）at 3，and 6 months after intervention.Results　Intervention method and time exerted significant interaction effect on FBG，2 hPBG，HbA1c，LDL-C，TG（P<0.05），but not on BMI，HDL-C and TC（P>0.05）.The main effects of intervention method on BMI，HDL-C and TC were not significant（P>0.05），but were significant on FBG，2 hPBG，HbA1c，LDL-C and TG（P<0.05）.The main effect of intervention time on BMI and TC was not significant（P>0.05），but was significant on FBG，2 hPBG，HbA1c，LDL-C，HDL-C and TG（P<0.05）.At the end of intervention，mean levels of FBG，2 hPBG，HbA1c，LDL-C and TG in the monitoring group were lower than those in the control group（P<0.05）.And FBG，2 hPBG，HbA1c，LDL-C and TG in the monitoring group were lower than before the intervention（P<0.05）.Conclusion　Intensive blood glucose monitoring by family doctors is helpful to improve the effect of blood glucose control in patients with type 2 diabetes and reduce the level of blood lipids，which deserves attention and promotion.