Study on community type 2 diabetes mellitus management model based on intelligent medical care under the background of normalization of anti-epidemic
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摘要:
目的 探讨抗疫常态化背景下基于智慧医疗的社区2型糖尿病管理模式的优势。 方法 以2020年在上海市浦东新区迎博社区卫生服务中心全科门诊就诊的2型糖尿病137例患者为研究对象,采用随机数字表法将患者分为对照组72例,研究组65例。对照组采用单纯1+1+1签约管理模式,研究组在对照组的基础上加入智慧医疗管理。观察2组在干预6个月后的血糖控制指标、代谢指标,糖尿病相关知识问卷(DRKQ)、糖尿病患者生存质量改善情况(DSQL)量表、自我行为管理变化情况(SDSCA)量表及用药依从性(MMAS-8)量表。 结果 经过6个月的干预后,研究组较对照组的血糖指标(空腹血糖降低约0.7 mmol/L,餐后2小时血糖降低约1.3 mmol/L)、血脂指标(TC降低约0.3 mmol/L、LDL-C降低约0.3 mmol/L)和血压指标(SBP降低约4 mmHg)均显著改善(P<0.05)。DRKQ量表显示2组受试者对糖尿病相关知识的知晓情况均有提高(P<0.001);DSQL量表显示研究组患者在干预后的生理、心理、社会适应、治疗以及生存质量方面的总得分均显著低于对照组(P<0.001);SDSCA量表显示干预后研究组自我饮食管理、运动、血糖监测、自我足部护理、按时用药方面均显著优于对照组(P<0.05);MMAS-8量表显示研究组在智慧医疗的指导下,用药依从性评分得到显著改善(P<0.001)。 结论 基于智慧医疗的管理模式可以更好地改善糖尿病患者的临床指标,并提升患者的自我管理能力、糖尿病知识知晓情况、生存质量和用药依从性。 Abstract:Objective To explore the advantages of a community type 2 diabetes mellitus management model based on smart medical treatment under the background of anti-epidemic normalization. Methods Patients with type 2 diabetes treated in Yingbo Community Health Service Center, Pudong New Area, Shanghai during 2020 were selected as the study objects and divided into intervention group and control group by random number table. A total of 137 diabetic patients (72 in the control group and 65 in the study group) were included. The control group adopted the simple 1+1+1 contract management mode, and the research group added smart medical management on the basis of the control group. Blood glucose control indexes, metabolic indexes, diabetes related knowledge questionnaire (DRKQ), improvement of diabetic specific quality of life (DSQL) scale, changes in summary of diabetes self care activities (SDSCA) scale, and Morisky medication adherence scale 8 (MMAS-8) scale were observed in the two groups after 6 months of intervention. Results After six months of intervention, compared with the control group, the blood glucose index (fasting blood glucose decreased by about 0.7 mmol/L, and blood glucose decreased by about 1.3 mmol/L two hours after meals), blood lipid index (TC decreased by about 0.3 mmol/L, LDL-C decreased by about 0.3 mmol/L), and blood pressure index (SBP value decreased by about 4 mmHg) in the study group were significantly improved (P < 0.05). The DRKQ scale showed that the knowledge about diabetes was improved in both groups (P < 0.001). The DSQL scale showed that the total scores of physiological, psychological, social adjustment, treatment, and quality of life in the study group were significantly lower than those in the control group (P < 0.001). SDSCA scale showed that after the intervention, self-diet management, exercise, blood glucose monitoring, self-foot care, and medication on time in the study group were significantly better than those in the control group (P < 0.05). The MMAS-8 scale showed that the medication compliance score of the study group was significantly improved under the guidance of smart medicine (P < 0.001). Conclusion The management model based on smart medicine can better improve the clinical indicators of patients with diabetes, and improve patients' self-management ability, diabetes knowledge, quality of life, and medication compliance. -
Key words:
- Intelligent medicine /
- Epidemic normalization era /
- Type 2 diabetes mellitus /
- Community
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表 1 2组2型糖尿病患者基线资料比较
Table 1. Comparison of baseline data between two groups of patients with type 2 diabetes
组别 例数 性别(男性/女性,例) 年龄(x±s,岁) 糖尿病病程(x±s,年) 高血压病程(x±s,年) 研究组 65 29/36 64.02±5.23 7.77±7.00 9.02±10.39 对照组 72 34/38 63.51±4.85 8.78±5.75 8.61±8.43 统计量 0.093a 0.582b 0.925b 0.251b P值 0.760 0.561 0.356 0.802 注:a为χ2值,b为t值。 表 2 2组2型糖尿病患者干预前后临床资料比较
Table 2. Comparison of clinical data before and after intervention between two groups of patients with type 2 diabetes
组别 例数 BMI(x±s) 收缩压(x±s,mmHg) 舒张压(x±s,mmHg) 腰臀比(x±s) 空腹血糖(x±s,mmol/L) 餐后2小时血糖(x±s,mmol/L) 干预前 预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 研究组 65 24.45±2.68 24.25±2.46 144.98±14.65 132.18±9.60 85.63±12.41 78.49±8.07 0.88±0.06 0.87±0.06 7.81±1.65 7.09±0.99 10.90±2.73 9.15±1.59 对照组 72 24.71±2.26 24.53±2.07 144.94±16.76 136.13±13.08 84.21±10.91 81.44±9.27 0.87±0.06 0.87±0.05 8.36±2.14 7.75±1.21 11.76±2.65 10.47±1.80 统计量 0.613a 0.323b 0.015a 6.360b 0.714a 8.003b 0.518a 2.503b 1.687a 9.609b 1.873a 20.449b P值 0.541 0.571 0.988 0.013 0.477 0.005 0.605 0.116 0.094 0.002 0.063 <0.001 组别 例数 糖化血红蛋白(x±s,%) 总胆固醇(x±s,mmol/L) 甘油三酯(x±s,mmol/L) 低密度脂蛋白(x±s,mmol/L) 尿微量白蛋白(x±s,μg/mL) 血尿酸(x±s,μmol/L) 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 研究组 65 7.86±1.49 6.92±0.78 5.35±1.29 4.72±0.97 1.83±1.07 1.70±1.07 2.97±0.95 2.36±0.69 47.53±72.63 36.54±63.43 343.48±77.66 324.15±59.44 对照组 72 8.06±1.36 7.35±0.90 5.18±1.03 5.06±1.04 2.24±1.79 1.92±1.31 2.85±1.07 2.62±0.81 38.4±70.75 37.97±72.01 347.25±89.86 339.99±71.78 统计量 0.800a 12.406b 0.886a 10.216b 1.665a 0.080b 0.683a 7.698b 0.744a 1.445b 0.262a 3.138b P值 0.425 0.001 0.377 0.002 0.099 0.777 0.496 0.006 0.458 0.231 0.794 0.079 组别 例数 血肌酐(x±s,μmol/L) 血压达标率[例(%)] 血糖达标率[例(%)] 血脂达标率[例(%)] 血糖与血压联合达标率[例(%)] 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 研究组 65 72.91±19.23 72.32±16.10 14(21.5) 23(35.4) 21(32.3) 38(58.5) 13(20.0) 1.426 8(12.3) 14(21.5) 对照组 72 69.46±14.27 71.04±15.53 16(22.2) 24(33.3) 15(20.8) 22(30.6) 9(12.5) 0.232 3(4.2) 6(8.3) 统计量 1.200a 0.922b 0.009c 0.064c 2.322c 10.807c 1.426c 4.403c 3.066c 4.778c P值 0.232 0.339 0.923 0.802 0.128 0.001 0.232 0.036 0.080 0.029 注:a为t值,b为F值, c为χ2值。 表 3 2组2型糖尿病患者干预前后糖尿病知识得分比较(x±s,分)
Table 3. Comparison of diabetic knowledge scores before and after intervention between two groups of type 2 diabetic patients(x±s, points)
组别 例数 干预前 干预后 t值 P值 研究组 65 25.14±5.95 33.65±3.58 18.863 <0.001 对照组 72 26.43±5.32 29.31±4.46 10.806 <0.001 统计量 1.342a 202.718b P值 0.182 <0.001 注:a为t值,b为F值。 表 4 2组2型糖尿病患者干预前后生存质量比较(x±s,分)
Table 4. Comparison of quality of life before and after intervention between two groups of patients with type 2 diabetes(x±s, points)
组别 例数 生理 心理 社会适应 治疗 生存质量总得分 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 研究组 65 24.82±6.04 21.83±4.49b 22.02±5.69 16.78±3.56b 8.12±1.50 6.94±1.53b 5.60±1.66 4.35±0.96b 60.55±11.25 49.91±7.61b 对照组 72 24.97±5.89 23.58±4.88b 20.42±4.98 19.03±4.15b 8.11±1.71 7.56±1.68b 5.72±1.47 5.03±1.05b 59.22±11.12 55.69±8.79b 统计量 0.154a 32.634c 1.752a 72.695c 0.043a 13.624c 0.458a 24.356c 0.696a 124.407c P值 0.878 <0.001 0.082 <0.001 0.965 <0.001 0.648 <0.001 0.488 <0.001 注:a为t值,c为F值。与同组治疗前比较,bP<0.05。 表 5 2组2型糖尿病患者干预前后自我管理评分比较
Table 5. Comparison of self-management scores before and after intervention between two groups of patients with type 2 diabetes
组别 例数 饮食(x±s,分) 运动(x±s,分) 血糖监测(x±s,分) 足部护理(x±s,分) 按时用药(x±s,分) 吸烟[例(%)] 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 研究组 65 14.77±4.87 17.31±2.78b 5.95±3.73 7.49±3.01b 2.20±2.65 2.95±2.53b 6.20±5.06 12.46±2.40b 6.40±1.37 6.98±0.12b 15(23.1) 14(21.5) 对照组 72 13.86±4.79 15.08±3.76b 6.39±4.30 6.89±3.90b 3.31±3.73 3.35±3.59b 7.26±5.09 9.22±3.71b 6.89±0.36 6.74±1.10b 16(22.2) 17(23.6) 统计量 1.100a 27.447c 0.629a 21.128c 1.657a 5.994c 1.225a 91.872c 2.926a 3.685c 0.014d 0.084d P值 0.273 <0.001 0.530 <0.001 0.100 0.016 0.223 <0.001 0.004 <0.001 0.905 0.772 注:a为t值,c为F值,d为χ2值。与同组治疗前比较,bP<0.05。 表 6 2组2型糖尿病患者干预前后用药依从性比较(x±s,分)
Table 6. Comparison of medication adherence before and after intervention between two groups of patients with type 2 diabetes(x±s, points)
组别 例数 干预前 干预后 t值 P值 研究组 65 5.80±1.80 6.98±1.26 6.675 <0.001 对照组 72 5.6±1.65 6.21±1.35 6.408 <0.001 统计量 0.536a 21.339b P值 0.593 <0.001 注:a为t值,b为F值。 -
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