摘要
目的通过对影响2型糖尿病患者规范化管理行为的因素进行分析，进一步完善2型糖尿病链式分层管理模式。方法（1）将人选我院2型糖尿病链式分层管理软件满一年以上的患者690例，分为糖化血红蛋白控制达标组（〈7．0％）、未达标组（≥7．0％），对两组患者的饮食控制、运动、用药、血糖自我监测、参加健康讲座的情况进行统计分析。（2）将入选的690例患者分为规范化管理组及非规范化管理组，将两组的年龄、性别、学历、职业状态、人均月收入、医疗保障、糖尿病病程、对糖尿病认知、双向转诊、慢性并发症情况进行统计分析。结果（1）糖化血红蛋白控制达标组在运动、血糖监测方面、参加健康教育方面比率均高于未达标组（比率分别为70．1％与54．2％，x2=6．163，P=0．018；60．4％与43．8％，X2=6．268，P=0．016；56．0％与41．7％，X2=4．577，P=0．045），差异均有统计学意义。（2）规范化管理组在年龄、学历、医疗保障、对糖尿病认知、双向转诊，并发症方面与未规范化管理组比较差异均有统计学意义[年龄：（61．08±10．04）岁与（57．75±9．89）岁，t=2．539，P=0．012；低学历比率：8．3％与17．2％，）（2=6．426，P=0．041；自费比率：4．6％与11．5％，x2=3．543，P=0．048；糖尿病认知差的比率：19．4％与41．0％，X2=17．518，P=0．000；未转或拒绝转诊比率4．6％与14．8％，X2=7．662，P=0．022；合并慢性并发症比率：41．7％与26．2％，）（2=6．130，P=0．017]。（3）经Logistic逐步回归分析显示：年龄、人均月收入、医疗保障、对糖尿病认知、未转或拒绝转诊、慢性并发症是影响患者规范化管理的影响因素（OR=0．954，P=0．006；OR=4．101，P=0．018；OR=7．617，P=0．003；OR=0．030，P=0．000；OR=9．079，P=0．000；OR=0．456，P=0．031）。结论应该针对影响患者规范化管理的影响因素包括年龄、人均月收入、医疗保障、对糖尿病认知、未转或拒绝转诊率、慢性并发症积极制定策略，完善2型糖尿病链式分层管理模式，使糖尿病患者早期参与规范化管理，延缓并发症的出现。
Objective To analysis the influence factors of standardization in the hierarchical chain management of type 2 diabetes and to enhance the hierarchical chain management of type 2 diabetes. Methods （ 1 ） Six hundred and ninty patients with type 2 diabetes completed 1 years management were divided into well- controlled glycosylated hemoglobin （HbAlc） group （ 〈 7.0% ） and bad-controlled glycosylated hemoglobin （HbAlc） group（ i〉7.0% ）. The conditions of diet, physical activity, medication, self-blood sugar monitoring and participation in health seminars were investigated and analyzed. （2） The patients were divided into standardized management group and not standardized management group. Their age, sex, educational background, occupation, monthly income per person, medical security, the course, cognition for glycuresis, two-way transfer, and chronic complications were investigated and statistically analyzed. Results （ 1 ） The proportions of physical activity （70. 1% vs 54. 2% , X2 = 6. 163, P = 0. 018 ） , self -blood sugar monitoring （ 60.4% vs 43.8 % , X2 = 6. 268, P = 0. 016） and participation in health seminars （56. 0% vs 41.7% , X2 = 4. 577 ,P = 0. 045 ） in the well-controlled HbAlc group were significantly higher than those in the bad-controlled HbAlc group. （ 2 ） Their age [ （ 61.08±10. 04） years old vs （ 57.75±9. 89 ） years old, t = 2. 539, P = 0. 012 ], educational background （ ratio of low educational attainment ：8.3 % vs 17. 2%, X2 = 6. 426, P = 0. 041 ）, medical security （ own expense ratios ：4. 6% vs 11.5% ,X2 = 3. 543, P = 0. 048 ）, awareness of diabetes （ ratio of poor awareness of diabetes： 19.4% vs 41.0% , X2 = 17. 518, P = 0. 000 ） , two-way transfer （ ratio of not transfer treatment ： 4. 6% vs 14. 8% , X2 = 7. 662 ,P = 0. 022 ） and chronic complications（ ratio of chronic complication ：41.7% vs 26. 2% , X2 = 6. 130 ,P = 0.017） were significantly different between the standardized management group and not standardized management group. （ 3 ） Logistic regression analyses indicated that the age （ OR = 0. 954, P = 0. 006 ）, monthly income per person （ OR = 4. 101, P = 0. 018 ）, medical security （ OR = 7. 617, P = 0. 003 ）, cognition for glycuresis （ OR = 0. 030, P = 0. 000 ）, two-way transfer （ OR = 9. 079, P = 0. 000 ） and chronic complications （ OR = 0. 456, P = 0. 031 ） were the risk factors of standardized managemem. Coneluslon We should focus on the impact factors affecting the standardized management of patients including age, monthly income per person, medical security, awareness of diabetes, ratio of not transfer treatment, positive strategies for chronic complications, improve the hierarchical chain management of type 2 diabetes, and then make the diabetic patients to early participate in standardization management of diabetes mellitus and delay the appearance of complications.
出处
《中国综合临床》
2012年第12期1264-1268,共5页
Clinical Medicine of China
基金
上海市徐汇区科学技术委员会研究基金（2009Y002）
关键词
2型糖尿病
链式分层管理
规范化
影响因素
Type 2 diabetes mellitus
Hierarchical chain management
Standardization
Influencing factors
