“互联网+医疗健康”智慧化医联体模式在儿童青少年糖尿病患儿管理中的应用

王晓艳; 张满燕

doi:10.16766/j.cnki.issn.1674-4152.004169

“互联网+医疗健康”智慧化医联体模式在儿童青少年糖尿病患儿管理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004169

王晓艳,
张满燕^,

绍兴文理学院附属医院儿科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2020ZH59

详细信息

通讯作者:
张满燕，E-mail：13567548189@163.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2025-02-19
- 网络出版日期: 2025-11-17

Application of "Internet+ Healthcare" smart medical consortium model model in the management of children and adolescents with diabetes mellitus

WANG Xiaoyan,
ZHANG Manyan^,

Department of Pediatrics, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的 “互联网+医疗健康”智慧化医联体模式是“互联网+医疗健康”与医联体的有机融合。儿童青少年糖尿病(DM)患儿的家属照顾负担重，关于“互联网+医疗健康”智慧化医联体模式在儿童青少年DM患儿中的应用效果尚缺乏报道，本研究对此进行探讨，旨在为优化儿童青少年DM患儿管理措施提供参考。方法选取2021年8月—2024年7月绍兴文理学院附属医院收治的80例儿童青少年DM患儿，采用随机数字表法分为观察组和对照组，每组各40例。对照组实施常规管理模式，观察组实施“互联网+医疗健康”智慧化医联体管理模式。2组均在6个月后评估血糖指标、治疗依从性等。结果管理后观察组空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血糖蛋白(HbA1c)均低于对照组[(7.16±1.05)mmol/L vs. (7.69±1.02)mmol/L，(8.94±1.33)mmol/L vs. (9.62±1.40)mmol/L，(8.95±1.08)% vs. (9.49±1.15)%，P＜0.05]。观察组日胰岛素剂量、住院时间、平均每月医疗费用、低血糖发生率均少于对照组(P＜0.05)。管理后观察组照顾者负担低于对照组，治疗依从性、家属满意度高于对照组(P＜0.05)。结论 “互联网+医疗健康”智慧化医联体模式应用于儿童青少年DM患儿管理能有效降低血糖水平，改善治疗依从性，减少日胰岛素剂量、住院时间、平均每月医疗费用及低血糖发生率，降低照顾者负担，提高家属满意度。
- 儿童青少年糖尿病 /
- 互联网+医疗健康 /
- 智慧化医联体 /
- 血糖
Abstract: Objective The "Internet+ Healthcare" smart medical consortium model represents the organic integration of "Internet+ Healthcare" and medical consortia. Given the heavy caregiving burden on families of children and adolescents with diabetes mellitus (DM), there remains a lack of reports on the application effects of this smart medical consortium model in managing pediatric and adolescent DM patients. This study explores its implementation to provide evidence-based references for optimizing management strategies for children and adolescents with diabetes mellitus. Methods A total of 80 children with DM in the Affiliated Hospital of Shaoxing University from August 2021 to July 2024 were selected. According to the random number table method, the patients were divided into an observation group and a control group, each with 40 cases. The control group implemented the conventional management mode, and the observation group implemented the "Internet+ Healthcare" smart medical consortium model. Both groups were evaluated after 6 months. Results After management, fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), and glycated hemoglobin A1c (HbA1c) in the observation group were lower than those in the control group [(7.16±1.05) mmol/L vs. (7.69±1.02) mmol/L, (8.94±1.33) mmol/L vs. (9.62±1.40)mmol/L, (8.95±1.08)% vs. (9.49±1.15)%, P < 0.05]. The daily insulin dose, length of hospital stay, average monthly medical expenses, and incidence of hypoglycemia in the observation group were lower than those in the control group (P < 0.05). After management, the caregiver burden in the observation group was lower than that in the control group (P < 0.05). Treatment compliance and family satisfaction in the observation group were higher than those in the control group (P < 0.05). Conclusion The application of the "Internet+ Healthcare" smart medical consortium model in the management of children and adolescents with DM has achieved remarkable results, which can effectively reduce blood glucose levels, improve treatment compliance, reduce daily insulin dose, hospital stay, average monthly medical costs and the incidence of hypoglycemia, reduce the burden of caregivers, and improve family satisfaction.
- Diabetes in children and adolescents /
- Internet+ Healthcare /
- Smart medical consortium model /
- Blood glucose

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表 1 2组儿童青少年DM患儿一般资料比较

Table 1. Comparison of baseline characteristics between the two groups of children and adolescents with DM

项目	观察组(n=40)	对照组(n=40)	统计量	P值
性别[例(%)]			0.050^a	0.823
男	22(55.00)	21(52.50)
女	18(45.00)	19(52.50)
年龄(x±s, 岁)	9.91±2.06	9.49±1.95	0.937^b	0.352
病程[例(%)]			0.145^c	0.885
＜1年	12(30.00)	10(25.00)
1~5年	17(42.50)	20(50.00)
＞5年	11(27.50)	10(25.00)
所处教育阶段[例(%)]			0.508^c	0.611
学龄前	3(7.50)	2(5.00)
小学	28(70.00)	27(67.50)
初中及以上	9(22.50)	11(27.50)
居住地[例(%)]			0.922^a	0.631
城市	12(30.00)	10(25.00)
城镇	17(42.50)	15(37.50)
农村	11(27.50)	15(37.50)
主要照顾者[例(%)]			0.507^a	0.776
父母	26(65.00)	25(62.50)
祖父母或外祖父母	12(30.00)	14(35.00)
其他	2(5.00)	1(2.50)
注：^a为χ²值，^b为t值，^c为U值。

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表 2 2组儿童青少年DM患儿血糖指标比较(x ±s)

Table 2. Comparison of blood glucose indexes between the two groups of children and adolescents with DM(x ±s)

组别	例数	FPG(mmol/L)		2hPG(mmol/L)		HbA1c(%)
组别	例数	管理前	管理后	管理前	管理后	管理前	管理后
观察组	40	10.65±1.83	7.16±1.05	13.56±2.04	8.94±1.33	10.29±1.48	8.95±1.08
对照组	40	10.17±1.74	7.69±1.02	12.99±2.17	9.62±1.40	10.53±1.55	9.49±1.15
统计量		1.202^a	12.369^b	1.210^a	11.674^b	0.708^a	11.985^b
P值		0.233	＜0.001	0.230	＜0.001	0.481	＜0.001
注：^a为t值，^b为F值。

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表 3 2组儿童青少年DM患儿治疗依从性比较[例(%)]

Table 3. Comparison of treatment compliance between the two groups of children and adolescents with DM[cases(%)]

组别	例数	FPG监测处方执行	其他时间点血糖监测处方执行	正确使用胰岛素	合理饮食	适当运动	定期复诊
观察组	40	38(95.00)	36(90.00)	37(92.50)	33(82.50)	33(82.50)	37(92.50)
对照组	40	30(75.00)	27(67.50)	30(75.00)	25(62.50)	24(60.00)	29(72.50)
χ²值		6.275	6.050	4.501	4.013	4.943	5.541
P值		0.012	0.014	0.034	0.045	0.026	0.019

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表 4 2组儿童青少年DM患儿日胰岛素剂量、住院时间、平均每月医疗费用、低血糖发生率比较

Table 4. Comparison of daily insulin dose, length of hospital stay, average monthly medical expenses and incidence of hypoglycemia between the two groups of children and adolescents with DM

组别	例数	日胰岛素剂量(x±s，U/kg)	总住院时间(x±s，d)	平均每月医疗费用(x±s，元)	低血糖[例(%)]
观察组	40	33.69±3.67	13.30±3.26	896.37±105.34	0
对照组	40	35.49±3.51	15.20±3.41	979.19±112.40	6(15.00)
统计量		2.242^a	2.547^a	3.400^a	4.505^b
P值		0.028	0.013	0.001	0.034
注：^a为t值，^b为χ²值。

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表 5 2组儿童青少年DM患儿照顾者负担比较[例(%)]

Table 5. Comparison of caregiver burden between the two groups of children and adolescents with DM[cases(%)]

组别	例数	管理前			管理后
组别	例数	轻度	中度	重度	轻度	中度	重度
观察组	40	8(20.00)	21(52.50)	11(27.50)	26(65.00)	12(30.00)	2(5.00)
对照组	40	7(17.50)	20(50.00)	13(32.50)	15(37.50)	18(45.00)	7(17.50)
Z值		0.450			2.363
P值		0.653			0.018

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表 6 2组儿童青少年DM患儿家属满意度比较[例(%)]

Table 6. Comparison of family satisfaction between the two groups of children and adolescents with DM[cases(%)]

组别	例数	不满意	满意	非常满意
观察组	40	2(5.00)	13(32.50)	25(62.50)
对照组	40	9(22.50)	14(35.00)	17(42.50)
注：2组满意度比较，Z=1.980，P=0.048。

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参考文献(20)

[1]	SAWYER A, SOBCZAK M, FORLENZA G P, et al. Glycemic control in relation to technology use in a single-center cohort of children with type 1 diabetes[J]. Diabetes Technol Ther, 2022, 24(6): 409-415. doi: 10.1089/dia.2021.0471
[2]	中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志, 2020, 58(6): 447-454. Endocrinology, Genetic and Metabolic Group, Pediatric Branch, Chinese Medical Association; Editorial Board, Chinese Journal of Pediatrics. Expert consensus on the standardized diagnosis and management of type 1 diabetes mellitus in Chinese children(2020)[J]. Chinese Journal of Pediatrics, 2020, 58(6): 447-454.
[3]	陈顺, 林雪梅, 袁乔英, 等. 1990—2019年中国儿童青少年1型糖尿病负担分析与模型预测[J]. 中国儿童保健杂志, 2024, 32(7): 746-751, 784. CHEN S, LIN X M, YUAN Q Y, et al. Burden analysis and model prediction of type 1 diabetes mellitus in Chinese children and adolescents from 1990 to 2019[J]. Chinese Journal of Child Health Care, 2024, 32(7): 746-751, 784.
[4]	DEMETERCO-BERGGREN C, EBEKOZIEN O, NOOR N, et al. Factors associated with achieving target alc in children and adolescents with type 1 diabetes: findings from the t1d exchange quality improvement collaborative[J]. Clin Diabetes, 2022, 41(1): 68-75.
[5]	HOLDER M, KAPELLEN T, ZIEGLER R, BÜRGER-BÜSING J, et al. Diagnosis, therapy and follow-up of diabetes mellitus in children and adolescents[J]. Exp Clin Endocrinol Diabetes, 2022, 130(S01): S49-S79.
[6]	国家卫生计生委, 国家中医药管理局. 关于印发进一步改善医疗服务行动计划(2018—2020年)[EB/OL]. (2017-12-29)[2023-05-04]. http//www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=9df87fced4da47b0a9f8e1ce9fbc7520.
[7]	喻杉, 彭倩, 陈靓, 等. 基于"互联网+专科医联体"的甘孜藏区膝骨关节炎阶梯化防治管理模式临床观察[J]. 四川中医, 2024, 42(1): 206-209. YU S, PENG Q, CHEN L, et al. Clinical Observation of a Stepwise Prevention and Management Model for Knee Osteoarthritis in Ganzi Tibetan Area Based on "Internet + Specialist Medical Consortium"[J]. Journal of Sichuan of Traditional Chinese Medicine, 2024, 42(1): 206-209.
[8]	ZHAO Y, WANG X. Effect of integrated nursing care based on medical alliance mode on the prevention and treatment of complications and self-efficacy of patients with coronary heart disease after PCI[J]. J Healthc Eng, 2022, 2022(1): 7727953. DOI: 10.1016/j.jmig.2018.02.002.
[9]	李红, 邓兰兰, 白琴, 等. 基于三级预防的"互联网+专科医联体"管理对痛风患者的影响[J]. 东南国防医药, 2020, 22(1): 88-90. LI H, DENG L L, BAI Q, et al. The Impact of "Internet + Specialist Medical Consortium" Management Based on Tertiary Prevention on Gout Patients[J]. Military Medical Journal of Southeast China, 2020, 22(1): 88-90.
[10]	巩纯秀. 儿童青少年糖尿病管理指南[M]. 2版. 北京: 科学出版社, 2019. GONG C X. Guidelines for the Management of Diabetes in Children and Adolescents (2nd Edition)[M]. 2nd Edition. Beijing: Science Press, 2019.
[11]	PINYOPORNPANISH K, PINYOPORNPANISH M, WONGPAKARAN N, et al. Investigating psychometric properties of the Thai version of the Zarit burden interview using rasch model and confirmatory factor analysis[J]. BMC Res Notes, 2020, 13(1): 120. DOI: 10.1186/s13104-020-04967-w.
[12]	HARVENGT A, MAURE A, BECKERS M, et al. Evaluation of severe hypoglycemia management in children and adolescents with type 1 diabetes in a Belgian tertiary pediatric care center: impact of intranasal glucagon and cost analysis[J]. Eur J Pediatr, 2025, 184(2): 162. DOI: 10.1007/s00431-025-05992-2.
[13]	ZIMMERMANN A T, LANZINGER S, KUMMERNES S J, et al. Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013-22): a longitudinal analysis of data from paediatric diabetes registries[J]. Lancet Diabetes Endocrinol, 2025, 13(1): 47-56. doi: 10.1016/S2213-8587(24)00279-1
[14]	张雪梅, 龙坤兰, 陈骏, 等. 采用"互联网+医疗"建立中医重症医联体"共生模式"的初步探究[J]. 中国中西医结合急救杂志, 2023, 30(1): 10-12. ZHANG X M, LONG K L, CHEN J, et al. Preliminary study on the establishment of a "symbiotic model" of the intensive care medicine consortium of traditional Chinese medicine by "internet+medical treatment"[J]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 2023, 30(1): 10-12.
[15]	FENG C, ZHU J, CHEN Y. The evolution and inter-sectoral interaction mechanism of China' s national medical alliance: an analysis based on complex systems theory[J]. Int J Health Plann Manage, 2022, 37(3): 1454-1476. doi: 10.1002/hpm.3413
[16]	ZHANG Q, LU Z, JING S, et al. Comprehensive evaluation of the implementation of close-type county medical alliance in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method[J]. BMC Health Serv Res, 2024, 24(1): 1193. DOI: 10.1186/s12913-024-11659-9.
[17]	闫珊, 沈慧, 顾智淳, 等. 新型智慧化管理模式在心房颤动患者社区随访管理中的效果评价[J]. 中华全科医学, 2024, 22(6): 1008-1012. doi: 10.16766/j.cnki.issn.1674-4152.003555 YAN S, SHEN H, GU Z C, et al. Evaluation of the effect of a new intelligent management model in community follow-up management of patients with atrial fibrillation[J]. Chinese Journal of General Practice, 2024, 22(6): 1008-1012. doi: 10.16766/j.cnki.issn.1674-4152.003555
[18]	武全莹, 郭立新, 孙超, 等. 医联体信息管理平台在社区2型糖尿病患者血糖自我监测管理中的应用[J]. 中华护理杂志, 2023, 58(24): 2949-2956. WU Q Y, GUO L X, SUN C, et al. Application of self-monitoring of blood glucose information management platform based on medical consortium in community patients with type 2 diabetes[J]. Chinese Journal of Nursing, 2023, 58(24): 2949-2956.
[19]	王婷婷, 顾威, 王玉冰. 儿童1型糖尿病照顾者负担现状与照顾者身心状况及患儿血糖控制效果的相关性研究[J]. 现代医学, 2022, 50(6): 764-768. WANG T T, GU W, WANG Y B. Correlation Study on the Current Status of Caregiver Burden, Caregivers' Physical and Mental Status, and Glycemic Control Outcomes in Children with Type 1 Diabetes[J]. Modern Medical Journal, 2022, 50(6): 764-768.
[20]	董海燕, 黄晓磊, 梁辉, 等. 安徽省紧密型城市医联体核心医院医务人员对双向转诊运行现状的认知及满意度研究[J]. 安徽医学, 2024, 45(1): 100-105. DONG H Y, HUANG X L, LIANG H, et al. A Study on the cognition and satisfaction of medical staff on the current situation of two-way referral in the core hospitals of compact urban medical associations in Anhui Province[J]. Anhui Medical Journal, 2024, 45(1): 100-105.