三高共管模式下基层社区老年糖尿病患者综合控制情况效果及影响因素研究

Clinical Efficacy of Integrated Hypertension-Hyperglycemia-Hyperlipidemia Management in Elderly Diabetic Patients: A Community-Based Intervention Study

摘要: 目的：探讨“三高共管”模式在基层社区老年糖尿病患者中的实施效果，为基层社区老年人慢病管理提供科学依据。方法：采用回顾性队列研究，基于平度市基本公共卫生管理平台及“三高”共管监测平台系统(2023~2024年数据)，选取连续2年完成国家基本公共卫生查体及“三高”并发症筛查的561例东阁街道 ≥ 65岁的老年糖尿病患者作为研究对象。收集患者一般信息、血压、实验室检查(空腹血糖、糖化血红蛋白、血脂四项)及生活方式(吸烟、饮酒、锻炼)等指标，以2023年为基线，采用Wilcoxon符号秩检验，McNemar检验进行配对分析；通过多因素多分类Logistic回归分析年龄、性别等因素对血糖、血压、血脂控制的影响。结果：与2023年相比，2024年HbA1c水平明显降低，FPG水平升高，差异均有统计学意义(p < 0.001)。2024年HbA1c、血脂、综合控制达标率分别为82.9%、17.5%、8.2%，显著高于2023年的45.5%、5.0%、0.9%，差异均有统计学意义(p < 0.001)。然而，2024年FPG、BP控制达标率分别为35.3%、30.7%均低于2023年的42.8%、48.0%差异均有统计学意义(p < 0.05)。生活方式各指标、脑血管并发症及用药情况的分布差异均无统计学意义(p > 0.05)。多因素多分类Logistic回归分析显示，居住地是血糖、血压控制变化的影响因素(p < 0.05)；与农村居民相比，城镇居民血糖控制变差的风险显著更高[OR (95%CI) = 2.128 (1.120~4.046), p = 0.021]，血压控制变差的风险显著更高[OR (95%CI) = 2.981 (1.932~4.600), p < 0.001]；性别是血压控制变化的影响因素(p = 0.013)，女性血压控制变好的风险显著低于男性[OR (95%CI) = 0.436 (0.249~0.765), p = 0.004]。结论：“三高共管”模式可显著提高老年糖尿病患者的HbA1c、血脂控制达标率。未来需优化政策执行，强化基层医疗资源配置，针对城乡差异、性别差异实施精准干预策略，为老年糖尿病患者打造个性化管理方案。

Abstract: Objective: To explore the implementation effect of the “Integrated 3H Management” model in elderly diabetic patients in primary healthcare Institutions and provide a scientific basis for chronic disease management in the elderly. Methods: The retrospective cohort study was conducted using data from the Pingdu Basic Public Health Management Platform and the “Integrated 3H Management Monitoring System” (2023~2024). This study enrolled 561 elderly diabetic patients aged 65 and above from Dongge Sub-district who had completed both the standardized national basic public health examinations and annual screenings for 3H complications for two consecutive years. Collect general patient information, blood pressure, laboratory tests (fasting blood glucose, glycated hemoglobin, and lipid profile), and lifestyle indicators (smoking, alcohol consumption, and exercise). Baseline data from 2023 were analyzed using Wilcoxon signed-rank tests, McNemar tests for paired comparisons. Multifactorial multicategory logistic regression analysis was used to assess the effects of age, sex, and other factors on the control of blood glucose, blood pressure, and blood lipids. Results: Compared with 2023, the HbA1c levels in 2024 showed a significant decrease, while FPG levels increased, with both differences being statistically significant (p < 0.001). The 2024 control rates for HbA1c, lipids, and comprehensive metrics were 82.9%, 17.5%, and 8.2%, respectively, significantly higher than the 2023 rates (45.5%, 5.0%, and 0.9%; p < 0.001). However, the compliance rates of FPG and BP in 2024 were 35.3% and 30.7% respectively, which were lower than 42.8% and 48.0% in 2023, and the differences were all statistically significant (p < 0.05). There were no statistically significant differences in lifestyle indicators, cerebrovascular complications, or medication regimens (p > 0.05). The results of multifactorial multicategory Logistic regression analysis demonstrated that residential location was a significant influencing factor for changes in blood glucose and blood pressure control (p < 0.05). Compared with rural residents, urban residents had significantly higher odds of worsened blood glucose control [OR (95%CI) = 2.128 (1.120~4.046), p = 0.021] and significantly higher odds of worsened blood pressure control [OR (95%CI) = 2.981 (1.932~4.600), p < 0.001]. Sex was a significant factor influencing blood pressure control changes (p = 0.013); Female patients had significantly lower odds of improved blood pressure control compared to males [OR (95%CI) = 0.436 (0.249~0.765), p = 0.004]. Conclusions: The Integrated 3H Management model significantly improved HbA1c and lipid control rates in elderly patients with diabetes. Future efforts should focus on refining policy implementation, strengthening primary healthcare resource allocation, and developing precise intervention strategies tailored to urban-rural and gender disparities to establish personalized management plans for elderly diabetic patients.