【摘要】 目的　探索糖尿病治疗的有效模式 ,提高社区糖尿病患者的治疗达标率 ,相对减少不必要的费用。方法　选择某综合性医院 (二级甲等 )为转诊中心 ,选择若干个社区街道医院 (一级甲等 )为转诊点 ,将 2 94例糖尿病患者按有关代谢指标及属地化管理的原则随机分组 ,设进行双向转诊的患者为转诊组 ( 1 0 0例 ) ,设不参加转诊 ,在一级甲等医院就诊的为对照Ⅰ组 ( 92例 ) ,在二级甲等医院就诊的为对照Ⅱ组 ( 1 0 2例 )。结果　转诊组 ;空腹血糖 (FPG)值平均控制为 ( 6 7± 1 4 )mmol/L ,餐后 2小时血糖 ( 2hPG)值平均控制为 ( 8 1± 3 2 )mmol/L ,糖化血红蛋白 (HbA1c)值控制为 ( 6 8±1 1 ) %;对照Ⅰ组FPG平均为 ( 7 8± 1 1 )mmol/L ,2hPG平均为 ( 9 3± 2 3 )mmol/L ,HbA1c为 ( 7 6± 1 1 ) %(P <0 0 1 ) ;对照Ⅱ组FPG平均为 ( 6 6± 1 8)mmol/L ,2hPG为 ( 8 2± 1 5 )mmol/L ,HbA2c为 ( 6 8± 0 6) %。在医疗费用方面 :转诊组平均为 ( 2 3 3± 3 9)元 /月 ,对照Ⅰ组平均为 ( 2 2 2± 4 5 )元 /月 (P >0 0 5 )。两者均低于对照Ⅱ组的 ( 2 72± 4 8)元 /月 (P <0 0 1 ) ,使总费用下降 1 4 3 %。结论　糖尿病的双向转诊模式初步疗效确切 ,费用与一级医院无明显差异 ,但可能取更多还原

【Abstract】 Objectives To investigate an effective mode for diabetes care to improve their metabolic status of patients with type 2 diabetes mellitus (2-DM) and decrease associated medical expense MethodsA two-way referral care system was settled with a secondaey-care general hospital as a center for diabetes care and several local primary-care hospitals at neighborhoods as referring points Totally, 294 patients of 2-DM who received their medical service at local hospitals were randomized into three groups, one referring group (100 cases) whose metabolic status was controlled by two-way referral care system, control group I (92 cases) cared only by a local primary-care hospital and control group II (102 cases) cared only by the secondary-care hospital Results Metabolic status in the patients of referring group was much better than that in control group I ( P <0 01), with their FPG of (6 7±1 4) mmol/L vs (7 8±1 1) mmol/L, 2hPG (8 1±3 2) mmol/L vs (9 3±2 3) mmol/L and HbA1c (6 8±1 1) % vs (7 6±1 1) % Average medical expense in referring group was almost the same as that in control group I, (233±39) vs (222±45) yuan / month per person, 14 30% lowered in both grouprs than that in control group II, (272±48) yuan / month per person, P <0 01 Conclusion Two-way referral care system was effective for patients with 2-MD, with the same good metabolic control in the secondary-care hospital, but lower medical expense更多还原