中国全科医学2017，Vol.20Issue(27)：3338-3342,5.DOI:10.3969/j.issn.1007-9572.2017.00.027
社区卫生服务中心与三甲医院联合管理模式对社区中心性肥胖2型糖尿病患者干预效果研究
Effect of Intervention on Type 2 Diabetic Patients with Central Obesity in the Community through Joint Management Mode between the Community Health Service Center and the Tertiary Grade A Hospital
摘要
Abstract
Objective To investigate the effect of intervention on type 2 diabetic patients with central obesity in the community through joint management mode between the Yuyuantan Community Health Service Center(YCHSC) and Beijing Tongren Hospital,CMU(hereafter referred to as a tertiary grade A hospital),which might be of great significance for the delivery of community health services.Methods This study is a sub-project of the Beijing Community Diabetes Study(BCDS).Totaled 119 subjects with type 2 diabetes mellitus were recruited from YCHSC between October 2012 and February 2013.Based on body mass index(BMI) and waist to height ratio(WHtR),central obesity was found in 74 cases of them(diabetes with central obesity group),but not in other 45 cases(diabetes without central obesity group).The study was implemented under the instructions of the endocrinology chief physicians of a tertiary grade A from the beginning to the end.Patient management standards were formulated by endocrinology chief physicians of a tertiary grade A and general practitioners(GPs) of YCHSC based on China Guideline for Type 2 Diabetes(2010 edition).All the participants received a 36-month multifactorial intervention delivered by the appointed chief general practitioner.The physical measurements and biochemical indicators〔body weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and uric acid〕 were measured before and after intervention.And prognostic endpoints occurred after intervention were recorded.The effect of the intervention was assessed after the intervention by evaluating and comparing the improvement achieved in both groups and between the groups,and comparing the incidence of prognostic endpoints between the groups.Results Before the intervention,body weight,SBP and TG in diabetes with central obesity group were higher than those in diabetes without central obesity group(P<0.05),while there were no significant differences in DBP,FPG,HbA1c,TC,HDL-C,LDL-C,and uric acid between the two groups(P>0.05).However,after the intervention,except the average value of FPG was higher in the diabetes with central obesity group(P<0.05),other indicators were similar in both groups(P>0.05).After the intervention,SBP,FPG and LDL-C were found to be decreased significantly but the average value of HDL-C increased obviously in the diabetes without central obesity group(P<0.05);in the diabetes with central obesity group,body weight,SBP were identified to be declined substantially but the average value of HDL-C increased notably(P<0.05).There were no significant differences in the incidence of stroke,coronary heart disease,diabetic nephropathy,diabetic retinopathy,and carotid plaque between the two groups after intervention(P>0.05).Conclusion Bad control of blood pressure and lipid profiles could be seen in type 2 diabetic patients with central obesity.Joint management mode between the community health service center and the tertiary grade A hospital for these patients can effectively improve the values of metabolic markers,and reduce the incidence of prognostic endpoints.关键词
糖尿病,2型/社区卫生服务/肥胖,腹部Key words
Diabetes mellitus,type 2/Community health services/Obesity/abdominal分类
医药卫生引用本文复制引用
王红秀,赵海,杨雪云,高丽伟,张雪莲,朱良湘,万钢,袁申元..社区卫生服务中心与三甲医院联合管理模式对社区中心性肥胖2型糖尿病患者干预效果研究[J].中国全科医学,2017,20(27):3338-3342,5.基金项目
国家自然科学基金资助项目(81300726) （81300726）
首都临床特色应用研究项目(Z151100004015021) （Z151100004015021）
首都卫生发展科研专项(2016-1-2057,2016-2-2054) （2016-1-2057,2016-2-2054）
首都卫生发展科研专项(2011-2005-01) （2011-2005-01）
