社区中老年2型糖尿病人群综合干预效果评价

目的评价社区中老年2型糖尿病患者综合干预效果。方法随机抽取上海市杨浦区五角场社区401名中老年2型糖尿病患者,随机分为干预组（n=216）和对照组（n=185）,进行为期3年干预。对干预组给予综合干预、控制达标、规范随防。对照组则给予常规治疗措施。结果中老年2型糖尿病人群血压、血脂水平随年龄增长而升高,血糖水平随年龄呈现U形曲线。干预组干预前后比较,收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、糖负荷2h血糖（2hPG）、甘油三酯（TG）、糖化血红蛋白（HbA1c）均不同程度下降,并发症发生率上升8.4%,其中大血管病变上升3.8%。而对照组则各代谢指标较实验前升高,其中FPG、TG升高显著,并发症发生率上升12.8%,其中大血管病变上升6.3%。干预组糖尿病知识认知水平明显高于对照组。结论①综合干预使中老年患者血压水平控制理想,但血糖、血脂控制较其他糖尿病患者更为困难。②即使代谢指标未能全部达标,但代谢水平的降低对于降低并发症的发生仍存在益处。③综合干预对部分糖尿病知识认知水平提高的作用显著,坚持糖尿病知识宣传教育是有必要及有成效的。

Effects of Community-based Integrated Interventions on Senile Patients with Type 2 Diabetes Mellitus

Objective To evaluate the effects of community-based integrated interventions on senile patients with type 2 diabetes mellitus（T2DM）.Methods 401 senile patients with T2DM from Wujiaochang communities in Yangpu District of Shanghai were randomized into intervention group（n=216） and the control group（n=185）.The intervention group received comprehensive intervention（three years）,control standards and standardized follow-up.The control group was given conventional treatment.Results In elderly population with T2DM,the levels of blood pressure and blood lipid increased with age,and the blood sugar levels showed U-shaped curve.After the interventions,the systolic blood pressure（SBP）,diastolic blood pressure（DBP）,fasting plasma glucose（FPG）,sugar load two hour blood glucose（2 h PG）,triglycerides（TG）,glycosylated hemoglobin（HbA1c） decreased,the complication rate rose 8.4%,and macrovascular complication increased 3.8% in the intervention group;while in the control group,the metabolism indicators were higher than that before intervention,FPG,TG increased significantly,the complication rate increased 12.8%,of which macrovascular complication rose by 6.3%.Diabetes cognitive knowledge of intervention group was significantly higher than that of control group.Conclusion ①By integrated intervention,the blood pressure control is ideal,but blood glucose and lipid control in senile patients with T2DM are still difficult as compared to other type diabetes mellitus patients.②Even if the metabolism indicators can not up to standard levels,a lower level of metabolism is still benefits in lowering the incidence of complications.③Integrated intervention play significant role on the part of awareness of diabetes knowledge,diabetes knowledge publicity and education is necessary and effective.