强调餐后2小时血糖监测的家庭医生团队管理模式对2型糖尿病患者血糖管理效果评价

Evaluation of the Effect of Family Doctor Team Management on Blood Glucose Management in Patients with Type 2 Diabetes after 2-Hour Postprandial Blood Glucose Monitoring

摘要: 目的：本研究旨在探讨通过强调餐后2小时血糖监测，采用家庭医生团队管理模式对老年糖尿病患者血糖控制效果进行评价，进而为家庭医生团队管理模式是否需要强化餐后2小时血糖监测提供切实证据。方法：本研究采取前瞻性队列研究，连续入选重庆市渝北区大湾中心卫生院2020-06~2020-12参加老年人免费体检，且确诊为2型糖尿病的患者共481例，其中4人因外出等原因被剔除，采用随机数字表法将患者分为对照组和干预组。其中对照组(女性142例，男性96例，n = 238)：只接受常规家庭医生团队管理，在对患者进行糖尿病随访时只监测空腹血糖。干预组(女性147例，男性92例，n = 239)：对患者进行糖尿病随访时不仅监测空腹血糖，还须监测餐后2小时血糖。同一时间段分别采取不同的管理模式，干预12个月后，再次检测并比较两组糖化血红蛋白(HbAlc)、空腹血糖(FBG)、餐后2小时血糖(2h-PBG)、血脂、舒张压(DBP)、收缩压(SBP)、体质指数(BMI)等指标，应用SPSS 22.0软件进行统计分析。对正态分布的资料采用t检验，P < 0.05表明差异具有统计学意义。结果：经为期12月的家庭医生团队管理后，两组BMI、HDL-C、TC等指标间差异无统计学意义(P > 0.05)；干预组FBG、2h-PBG、HbAlc及TG、LDL-C、舒张压、收缩压等均优于对照组，差异具有统计学意义(P < 0.05)。结论：强调餐后2小时血糖监测的家庭医生团队管理模式，能够有效控制糖尿病患者血糖及血脂水平，具有临床推广应用价值。

Abstract: Objective: The study aims to evaluate the effect of family doctor team management on the glycemic control of elderly diabetic patients in the community by emphasizing 2 hours postprandial blood glucose monitoring, so as to provide tangible evidence for whether the family doctor team management mode needs to strengthen the 2 hour postprandial blood glucose monitoring. Methods: A prospective cohort study was conducted. 481 consecutive patients were enrolled in the 2020-06~2020-12 of the Da Wan Health Center in Yubei District, Chongqing. 481 of them were diagnosed with type 2 diabetes and 4 were excluded for reasons such as going out. The patients were randomly divided into control group (142 females, 96 males, n = 238): Only received routine family doctor team management, only fasting blood glucose was monitored during follow-up. Intervention group (147 women, 92 men, n = 239): Fasting blood glucose and 2-hour postprandial blood glucose were monitored during follow-up. At the same time, different management modes were adopted. After 12 months of intervention, BMI, SBP, DBP, HbAlc, FBG, 2h-PBG of two groups were detected and compared again. SPSS 22.0 software was used for statistical analysis. The data of normal distribution were tested by t-test, P < 0.05, which showed that the difference was statistically significant. Results: Comparison of the changes of the above indexes between the two groups before and after intervention: After 12 months of family doctor team management, there was no significant difference between the two groups in BMI, HDL-C, TC and other indexes (P > 0.05); FBG, 2h-PBG, HbAlc, TG, LDL-C, diastolic blood pressure and systolic blood pressure in the intervention group were better than those in the control group (P < 0.05), the results showed that the difference was statistically significant. Conclusion: The family doctor team management mode emphasizing 2 hours postprandial blood glucose monitoring can effectively control the blood sugar and blood lipid level of diabetics, and is worthy of clinical popularization and application.