【摘要】 目的研究北京市朝阳区三里屯社区卫生服务中心9年强化管理对2型糖尿病(T2DM)患者糖尿病微血管并发症的影响,探索血糖、血压、血脂水平及联合达标≥3次与微血管并发症预后的关系。方法将三里屯社区2008年入选的224例T2DM患者随机分为强化组(113例)和标准组(111例),对其连续管理并随访9年,以收缩压、舒张压、糖化血红蛋白(Hb A1c)、低密度脂蛋白胆固醇(LDL-C)为主要管理指标,比较管理前后两组上述指标的差异;收集终点事件(糖尿病视网膜病变和糖尿病肾病),比较管理后两组终点事件的发生情况;探索分组管理方式和主要指标达标次数是否≥3次与微血管并发症的关系。结果入组时两组患者性别、年龄、病程、吸烟情况、BMI、收缩压、舒张压、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、LDL-C、Hb A1c及尿微量清蛋白排泄率(UAER)比较,差异无统计学意义(P>0.05);管理后强化组FPG、2 h PG、LDL-C、Hb A1c、UAER水平低于标准组,差异有统计学意义(P<0.05);两组BMI、收缩压、舒张压比较,差异无统计学意义(P>0.05)。标准组发生或加重的糖尿病视网膜病变6例(5.4%),糖尿病肾病13例(11.7%);强化组发生或加重的糖尿病视网膜病变1例(0.9%),糖尿病肾病5例(4.4%)。两组视网膜病变发生率、糖尿病肾病发生率比较,差异有统计学意义(P<0.05)。Hb A1c和联合达标≥3次的患者微血管病变发生率低于Hb A1c和联合达标<3次的患者,差异有统计学意义(P<0.05)。结论社区T2DM强化管理可有效减少糖尿病视网膜病变和糖尿病肾病的发生;Hb A1c达标、联合达标次数≥3次,更可明显减少上述并发症的发生,提高患者生存质量。更多还原

【Abstract】 Objective To study the effect of a 9-year intensive diabetes management conducted by Beijing Sanlitun Community Health Center on the incidence rate of diabetic microvascular complications(DMCs) in patients with type 2 diabetes mellitus(T2 DM) and to explore the relationship of meeting the control targets of fasting plasma glucose(FPG),blood pressure and blood lipids for 3 times or more with the incidence rate of DMCs in this population.Methods The participants were 224 T2 DM patients enrolled from Sanlitun Community in 2008.They were randomized into the intensive management group(n=113) and standard management group(n=111),receiving intensive management and follow-up,standard management and followup,respectively,for consecutive 9 years.Comparisons were made between two groups in terms of systolic blood pressure(SBP),diastolic blood pressure(DBP),glycosylated hemoglobin(Hb A1 c) and low-density lipoprotein cholesterol(LDL-C) at baseline and at the end of management,and in regard to outcome events(diabetic retinopathy and diabetic nephropathy).To investigate the relationship of management method and meeting the control targets of FPG,blood pressure and blood lipids for 3 times or more with the incidence of DMCs.Results There were no significant differences in the distribution of sex,age,duration of T2 DM,BMI,prevalence of smoking,mean SBP,DBP,FPG,2 h PG,LDL-C,Hb A1 c and urinary albumin excretion rate(UAER) at baseline between the two groups(P>0.05).At the end of management,mean FPG,2 h PG,Hb A1 c,LDL-C and UAER were much lower in the intensive management group(P<0.05) except the distribution of BMI,mean SBP and DBP were still similar in both groups(P>0.05);the intensive management group showed lower incidence and exacerbation rates of diabetic retinopathy [0.9%(1/113) vs 5.4%(6/111)] and lower incidence and exacerbation rates of diabetic nephropathy [4.4%(5/113) vs 11.7%(13/111)](P<0.05).A much lower rate of DMCs was found in those meeting the target objective for Hb A1 c as well as those meeting the control targets of FPG,blood pressure and blood lipids for 3 times or more in both groups(P<0.05).Conclusion The incidence rate of DMCs in T2 DM patients can be effectively reduced by community-based intensive diabetes management.Moreover,it will be lower and improved quality of life will be achieved if the Hb A1 c reaching the target objective or FPG,blood pressure and blood lipids meeting the control targets for 3 times or more.更多还原