奉賢東區糖尿病胰島素類似物結構化管理初步探討

黃國蘭　李玢　楊衛紅　季龍琴　金丹丹

【摘要】 目的：對奉賢東部地區糖尿病患者進行胰島素類似物結構化管理模式的研究，以探討胰島素類似物結構化管理模式干預對奉賢區2型糖尿病患者血糖水平、行為和認知的影響，為區域性單病種高質量管理應用提供理論依據。方法：選取奉賢東部地區100例口服降糖藥物但血糖依然控制不住的2型糖尿病患者，采用隨機、平行對照臨床研究方法，將患者隨機分為結構化管理模式干預組（結構化管理模式）和對照組（常規醫療模式），各50例，兩組均皮下注射諾和銳30。比較兩組干預前后的糖化血紅蛋白（HbA1c）、7點血糖譜、行為和認知改變評分、BMI和空腹C-肽（C-P）。結果：干預16周后，結構化管理模式干預組7點血糖譜、HbA1c均低于干預前及對照組（P<0.05），空腹C-P高于干預前、BMI低于干預前（P<0.05），但兩組空腹C-P、BMI比較，差異均無統計學意義（P>0.05）;干預16周后，結構化管理模式干預組行為和認知評分均高于治療前及對照組，差異均有統計學意義（P<0.05）。結論：使用諾和銳30治療并接受結構化管理模式干預的2型糖尿病患者血糖、BMI控制效果更好，低血糖發生風險更低，患者行為和認知更好，對結構化管理模式在該區域的推廣具有一定的指導意義。

【關鍵詞】 2型糖尿病; 諾和銳30; 結構化管理; 奉賢東區

【Abstract】 Objective：To study the structured management model of insulin analogues in patients with diabetes mellitus in eastern Fengxian District，to explore the effects of the intervention of structured management model of insulin analogues on blood sugar level，behavior and cognition of type 2 diabetes mellitus in FengxianDistrict，so as to provide theoretical basis for the application of regional single disease high quality management.Method：A total of 100 patients with type 2 diabetes mellitus who took oral hypoglycemic drugs but still had uncontrollable blood sugar in eastern Fengxian District were selected.According to the randomized，parallel controlled clinical research method，they were randomly divided into structured management model intervention group（structured management model）and control group（conventional medical model），50 cases in each group，they were subcutaneously injected with Novoxel 30.The glycosylated hemoglobin（HbA1c），7-point blood glucose profile，behavioral and cognitive change score，BMI and fasting C-peptide（C-P）before and after intervention between two groups were compared.Result：After 16 weeks of intervention，the 7-point blood glucose profile and HbA1c instructured management model intervention group were lower than those of before intervention and control group（P<0.05），the fasting C-P was higher than that of before intervention，and the BMI was lower than that of before intervention（P<0.05），but the fasting C-P and BMI of two groups were compared，the differences were not statistically significant（P>0.05）.After 16 weeks of intervention，the behavioral and cognitive scores of structured management model intervention group were higher than those of before intervention and control group，the differences were statistically significant（P<0.05）.Conclusion：Patients with type 2 diabetes treated with Novotel 30 and intervened by structured management model，the control effect of blood sugar and BMI is better，the risk of hypoglycemia is lower，and patients behavior and cognition are better，it has certain guiding significance for the promotion of structured management model in this region.