摘要
目的探讨“胰岛素管理单元”模式与常规治疗模式相比，对本社区血糖控制不佳且接受胰岛素治疗的2型糖尿病患者的干预效果。方法（1）筛选出在本院糖尿病门诊建档，HbA1C≥8％且注射胰岛素的2型糖尿病患者55例，分为标准组及强化组，分组前均进行糖尿病知识教育并采集个人信息、生化检查、空腹血糖、HbA1C、并记录目前治疗方案、每日胰岛素剂量、每月低血糖发生频率；（2）强化组患者免费提供血糖仪一台，要求每日至少自我监测血糖2-3次，社区医生每周电话随访一次，询问血糖监测、低血糖发生等情况并指导方案调整，每月门诊随访一次。标准组每月常规门诊就诊一次或以上，由同一医生根据情况调整治疗方案。两组患者随访时间均为6个月，分别在第3个月及研究结束时复查血糖、生化、HbA1C，等指标，并记录2组每日胰岛素剂量及自我上报的低血糖发生频率。结果标准组及强化组患者HbA1C，从基线时的9．14％±1．24％、9．33％±1．14％分别降至8．65％±1．28％、7．40％±0．91％；2组基线时自测血糖频率为4次／月，干预后强化组的血糖自测频率明显增高（5次／月对50次／月，P〈0．01）；干预后强化组自我上报低血糖概率增高（1次／月对3次／月，P〈0．01）；强化组最高胰岛素每日平均剂量较基线时增加6U，但无统计学差异。结论通过6个月的强化管理能使注射胰岛素患者的血糖控制明显改善，且未明显增加胰岛素剂量，此“胰岛素管理单元”模式安全有效。
Objective To assess the impact of intervention with ＂Insulin therapy management unit＂ program in the poorly controlled type 2 diabetic patients in a community of Shanghai. Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia （ HbAlc ≥ 8% ） enrolled in this study. They were divided at random into 2 groups： intensive care group and standard care group. The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day. Community health provider acquired information of blood glucose level, episodes of hypoglycemia, and dosage of insulin every week by cell phone. Standard care patients received diabetes care from the same provider in outpatient clinic every month. Results By the end of 6 months of intervention, the intensive care group showed a significant difference in HbAlc as compared to the standard care group （7.40% ±0.91% vs 8.65% ± 1.28% , P〈0.01 ）. The frequency of self-monitoring of blood glucose （SMBG） was 4 times per month in both groups at baseline. After intervention, the frequency of SMBG in intensive care group was greatly increased compared to standard care group （50 times per month vs 5 times per month, P〈0.01 ）. The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group （3 times per month vs once per month, P〈0.01 ）. The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study（ P〉0.05 ）. Conclusion After 6 months of intervention, the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly. The ＂ Insulin therapy management unit＂ is effective and safe.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2014年第2期101-105,共5页
Chinese Journal of Endocrinology and Metabolism
关键词
糖尿病
胰岛素
低血糖
自我血糖监测
社区保健服务
Diabetes mellitus
Insulin
Hypoglycemia
Self-monitoring of blood glucose
Community heahhservices
