对老年糖尿病慢性并发症患者实施一体化管理的效果评价

目的 调查老年糖尿病慢性并发症患者的治疗现状,并评价对其实施一体化管理的效果,为促进一体化管理模式的完善和推广提供依据.方法 纳入老年糖尿病慢性并发症患者88例,按患者意愿,纳入传统的自我管理的46例患者作为对照组,纳入医院-社区-家庭一体化管理的42例患者作为一体化组.随访1年,所有患者随访前后均评估汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、生存质量特异性量表（A-DQOL）,进行空腹血糖（FPG）、餐后2h血糖（2 h PG）、糖化血红蛋白（HbA1c）、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）的测定,并计算治疗2型糖尿病及其并发症的相关医疗费用.结果 两组管理前各项指标比较差异均无统计学意义（P＞0.05）.一体化组管理后1年FPG、2hPG、HbA1c、月均低血糖次数、TC、TG、LDL-C、DBP、住院费用、直接医疗费用、HAMA评分、A-DQOL评分均较对照组明显降低[（7.36±1.21） mmol/L比（9.11±1.82） mmol/L、（9.01±2.14）mmol/L比（14.22±3.23）mmol/L、（7.26±1.19）％比（8.84±1.80）％、（0.84±1.08）次/月比（3.13±2.58）次/月、（4.37±0.48）mmol/L比（4.96±0.52） mmol/L、（1.44±0.29） mmol/L比（1.75±0.27） mmol/L、（2.38±0.38） mmol/L比（2.90±0.60） mmol/L、（80.37±10.42） mmHg（1 mmHg=0.133 kPa）比（89.23±14.76） mmHg、（478.70±544.65）元比（977.85±585.35）元、（1 681.92±623.62）元比（1 950.43±563.36）元、（14.50±3.55）分比（17.23±4.28）分、（96.29±15.67）分比（107.90±15.31）分],差异有统计学意义（P＜0.01）,SBP、HAMD评分均较对照组降低[（130.66±12.52） mmHg比（138.87±16.41） mmHg、（18.55±4.16）分比（21.10±4.33）分],差异有统计学意义（P＜0.05）,月均血糖监测次数较对照组明显增多[（30.55±16.98）次/月比（8.65±7.47）次/月],差异有统计学意义（P＜0.01）.结论 对老年糖尿病慢性并发症患者实施个体化治疗策略的一体化管理,可以改善患者的糖脂代谢紊乱,减少住院费用,并且能够改善患者焦虑、抑郁症状及生存质量.

Evaluation on the efficacy of integrated management on elderly type 2 diabetes mellitus patients with chronic complications

Objective To investigate the current treatment of elderly type 2 diabetes mellitus （T2DM） patients with chronic complications and assess the effect of integrated management on them,so as to provide basis for the improvement and popularization of the mode.Methods Eighty-eight elderly T2DM patients with chronic complications were selected in this study,according to the wishes of the patients,46 cases with traditional way of self-management patients as control group,and 42 cases with hospital-community-family integrated management patients as integrated group,all the patients were followed up for 1 year,all the patients were assessed with Hamilton depression scale （HAMD）,Hamilton anxiety scale （HAMA） and the Adjusted Diabetes Quality-of-life Measure （A-DQOL）.The fasting plasma glucose（FPG）,2-hour postprandial plasma glucose （2 h PG）,glycosylated hemoglobin （HbA1c）,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,total cholesterol （TC）,triglyceride （TG）,and low-density lipoprotein cholesterol （LDL-C） were measured,and the medical costs for treating T2DM and its complications was calculated.Results The index before management between 2 groups had no significant difference （P 〉 0.05）.After management for 1 year,the FPG,2 h PG,HbA1c,frequency of hypoglycemia per month,TC,TG,LDL-C,DBP,hospital costs,direct medical costs,HAMA scores and A-DQOL scores in integrated group were significantly lower than those in control group [（7.36 ± 1.21） mmol/L vs.（9.11 ± 1.82） mmol/L,（9.01 ± 2.14） mmol/L vs.（14.22 ± 3.23） mmol/L,（7.26 ± 1.19）% vs.（8.84 ± 1.80）%,（0.84 ± 1.08） times/month vs.（3.13 ± 2.58） times/month,（4.37 ± 0.48） mmol/L vs.（4.96 ± 0.52） mmol/L,（1.44 ± 0.29） mmol/L vs.（1.75 ± 0.27） mmol/L,（2.38 ± 0.38） mmol/L vs.（2.90 ± 0.60） mmol/L,（80.37 ± 10.42） mmHg （1 mmHg =0.133 kPa） vs.（89.23 ± 14.76） mmHg,（478.70 ±544.65） yuan vs.（977.85 ±585.35） yuan,（1 681.92 ± 623.62） yuan vs.（1 950.43 ± 563.36） yuan,（14.50 ± 3.55） scores vs.（17.23 ± 4.28） scores,（96.29 ± 15.67） scores vs.（107.90 ± 15.31） scores] （P 〈 0.01）,SBP and HAMA scores were lower than those in control group [（130.66 ± 12.52） mmHg vs.（138.87 ± 16.41） mmHg,（18.55 ± 4.16） scores vs.（21.10 ± 4.33） scores] （P 〈 0.05）,frequency of blood glucose monitoring per month was significantly higher than that in control group [（30.55 ± 16.98） times/month vs.（8.65 ±7.47） times/month] （P 〈0.01）.Conclusions In elderly T2DM patients with chronic complications,integrated management with individual treatment strategy can significantly improve metabolic disorders,decrease hospital costs,improve the symptoms of anxiety and depression,and improve quality of life.