摘要
目的探讨启用基础胰岛素治疗的深圳2型糖尿病患者人群特点及其优化管理效果。方法2014年4月至2017年12月间入组"基础胰岛素临床规范化使用优化管理项目"(简称"三人行"项目)的深圳4家医院的4535例患者,深圳"三人行"项目在遵循全国"三人行"项目实施原则基础上,通过以项目护士为主导的"首日标准化教育"及12周"随访督促"对患者进行优化管理;以空腹血糖(FPG)作为优化评估指标,随访结束时至少提交过1次FPG患者4089例。将深圳"三人行"初期(2014年4月至2015年4月)数据分别与同期发表的全国"三人行"数据及深圳"三人行"后期(2015年5月至2017年12月)数据进行比较,以了解深圳启用基础胰岛素治疗的患者特点,并以优化管理后FPG及FPG达标率评价优化管理效果。两组间比较采用t检验,率的比较采用卡方检验。结果深圳"三人行"初期患者基线数据与全国"三人行"同期数据相比,年龄、病程及初始FPG水平相当(均P >0.05),既往降糖方案中单纯口服药比例更高[69.6%(355/510)比51.6%(38964/75467),χ^2=65.612,P<0.05];随访结束时,FPG水平更优[(6.5±1.8)比6.9mmol/L,t=5.377,P<0.05],FPG总体达标率更高[78.9%(358/454)比62.6%(40334/64420),χ^2=50.879,P<0.05]。后期深圳"三人行"患者基线数据与初期相比,年龄更轻[(53.0±13.6)比(55.6±14.2)岁,t=4.094,P<0.05]、初始FPG和糖化血红蛋白更高[(12.8±4.8)比(10.9±4.2)mmol/L,(10.3±2.2)%比(9.5±2.4)%,t=8.583、3.661,均P<0.05];随访结束时,FPG水平更低[(6.2±1.3)比(6.5±1.8)mmol/L,t=3.661,P<0.05],总体FPG达标率更高[84.9%(3085/3635)比78.9%(358/454),χ^2=10.976,P<0.05]。结论需启用基础胰岛素治疗的深圳2型糖尿病患者,在积极口服降糖药治疗后血糖仍控制不佳,提示深圳基础胰岛素启用时间滞后,存在临床惰性;经护士为主导的优化管理后,患者FPG达标率显著提高,提示在深圳的糖尿病教育及优化管理建设中充分发掘专科护士的作
Objective To investigate the clinical characteristics and effective management of type 2 diabetic patients with initiating basal insulin therapy in Shenzhen. Methods A total of 4 535 patients in 4 hospitals from April 2014 to December 2017 were enrolled in "The Basic Insulin Clinical Standardized Use and Effective Management Program" in Shenzhen (Shenzhen "TRIO" Study). The program was managed by project nurses, patients were providedby standardized education at first day, and followed up with optimized management and supervision for 12 weeks. Fasting blood glucose (FPG) levels were monitored as an optimization evaluation index in the program. At the end of the follow-up, FPG levels from 4 089 patients were examined at least once. We compared our early data (from April 2014 to April 2015) from Shenzhen "TRIO" Study with the data from national "TRIO" Study, and the later data (from May 2015 to December 2017) from Shenzhen "TRIO" Study. Results Compared with national "TRIO" Study, the type 2 diabetic patients in early Shenzhen "TRIO" Study had similar age, diabetes duration and baseline FPG (all P >0.05), but there was significantly higher percentage of patients who were treated with oral anti-diabetic drugs only in Shenzhen study (69.6% (335/510) vs 51.6% (38 964/75 467), χ^2=65.612, P<0.05). At the end of follow-up, the average FPG levels in patients were lower in Shenzhen study [(6.5±1.8) vs 6.91 mmol/L, t=5.377, P<0.05], and the FPG control rateswere higher (78.9% (358/454) vs 62.6% (40 334/64 420), χ^2=50.879, P<0.05). Compared with the baseline data in early Shenzhen "TRIO" Study, the patients from late Shenzhen Study hadyounger age [(53.0±13.6) vs (55.6±14.2) years, t=4.094, P<0.05], higher FPG levels and HbA1c [(12.8±4.8) vs (10.9±4.2) mmol/L, (10.3±2.2)% vs (9.5±2.4)%, t=8.583, 3.661, all P<0.05]. At the end of follow-up, the average FPG levels were lower [(6.2±1.3) vs (6.5±1.8) mmol/L, t=3.661, P<0.05], and the FPG control rates were higher (84.9% (3 085/3 635) vs 78.9% (358/454), χ^2=10.976,
作者
刘雪婷
贾黎静
陆泽元
顾建芬
阎德文
Liu Xueting;Jia Lijing;Lu Zeyuan;Gu Jianfen;Yan Dewen(Department of Endocrinology,Shertzhen Second People's Hospital,Shenzhen 518035,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2018年第12期777-782,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
深圳市科技研发资金技术攻关项目(JSGG20160331103247408).
