中国全科医学2017，Vol.20Issue(25)：3109-3116,8.DOI:10.3969/j.issn.1007-9572.2017.25.010
2型糖尿病管理八年联合达标对心血管事件及全因死亡的影响研究
An Eight-year Cohort Study of the Effect of the Joint Control on Cardiovascular Events and All-cause Mortality with Type 2 Diabetes Mellitus
摘要
Abstract
Objective To investigate the effect of the eight-year joint control on cardiovascular events and all-cause mortality with type 2 diabetes mellitus (T2DM).Methods In the Beijing Community Diabetes Study (BCDS) project,441 patients with T2DM from Jinsong Cormunity Health Service Center were enrolled from August to December in 2008 and followed up to September 2016.No case was drop-out.The patients were divided into the intensive management group (n =220) and the standard management group (n =221) through the random number table.The patients in two groups were regularly monitored by their family doctors with a one-to-one basis under the guidance of experts from first-class hospitals during the follow-up period.All the metabolic variables were detected,and the early detection and intervention of complications were carried out.The main differences in managements between two groups were the period of follow-up and the monitoring frequency of important indicators,including the indicators of glycosylated hemoglobin (HbA1c) and urinary albumin excretion rate (UAER).The patients in the intensive management group were followed up every 2 months,detected HbA,c every 3 months and detected UAER every 6 months,while the patients in the standard management group were followed up every 3 months,detected HbA1c every 6 months and detected UAER every 12 months.The related metabolic parameters between these two groups were compared from 2008 to 2016.The up to standard rate of joint control and the incidence of endpoint events were also compared at the same time to analyze the effect of the up to standard times of joint control on cardiovascular events and all-cause mortality.Results The up to standard rate of FPG in the intensive management group was lower than that of the standard management group in 2012.The up to standard rate of FPG,HbA1c,LDL-C and joint control in the intensive management group were higher than that of the standard management group from 2015 to 2016.The up to standard rate of blood pressure in the intensive management group was higher than that of the standard management group in 2015.All these differences were statistically significant (P ＜ 0.05).However,there were no significant differences betweeu two groups in the incidence of all-cause deaths,cerebrovascular events,cardiovascular events,diabetic nephropathy,diabetic retinopathy,peripheral vascular events,tumor and total endpoint events (P ＞ 0.05).A total of 139 patients (31.5％) were up to standard more than 3 times,while the rest of 302 patients (68.5％) were up to standard less than 3 times.The incidence of all-cause deaths,cardiovascular events and total endpoint events in patients who were up to standard more than 3 times was lower than that of patients who were up to standard less than 3 times (P ＜0.05).The log-rank test showed that the cumulative risks of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times were significantly lower than that of patients who were up to standard less than 3 times (P ＜ 0.05).The incidence of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times was lower than that of patients who were up to standard less than 3 times,and the difference was statistically significant in the sixth year of joint management (P ＜ 0.05).Conclusion The joint control model of community health service centers and first-class hospitals could effectively improve the reaching standard rate of joint control in patients with type 2 diabetes mellitus.The incidence of all-cause deaths and cardiovascular events in patients who were up to standard more than 3 times decreased significantly in the sixth year of joint control.关键词
糖尿病,2型/健康管理/联合达标率/心血管事件/全因死亡Key words
Diabetes mellitus, type 2/Health management/Joint control rate/Cardiovascular event/All-cause mortality分类
医药卫生引用本文复制引用
庄宁,刘海青,张丽娟,李桂英,闫军生,邢佳,冯云飞,许国庆,崔亚丽,张帆,徐保真,张建东,杨光燃,袁申元,万钢,高丽娟,边川,陈怀宁,池清,贾秋香,苏艳丽..2型糖尿病管理八年联合达标对心血管事件及全因死亡的影响研究[J].中国全科医学,2017,20(25):3109-3116,8.基金项目
首都卫生发展科研专项(2016-1-2057、2016-2-2054) （2016-1-2057、2016-2-2054）
首都临床特色应用研究项目(Z151100004015021) （Z151100004015021）
国际糖尿病联盟IDF-BRIDGES 4th Round of Funding(ST12-024) （ST12-024）
