综合管理有助于1型糖尿病血糖控制
Disease-management programs improve glycemic control in type 1 diabetic patients
目的 探讨综合管理对1型糖尿病(T1DM)血糖控制的影响.方法 纳入2010年8月6日至2013年1月1日在中山大学附属第三医院就诊随访的T1DM患者,实施综合管理,包括3个月1次的规律随访、糖尿病教育、治疗方案调整及免费的糖化血红蛋白(HbA1c)检测等.根据HbA1c是否达到相应年龄段的血糖控制目标将患者分为达标组和未达标组.采用logistic回归模型分析HbA1c达标与各因素的相关性.结果 共纳入144例T1DM患者,男64例,女80例,中位年龄29.0岁(四分位间距22.0,38.0,下同),糖尿病病程4.5年(2.8,9.0),体质指数(BMI) 19.8 kg/m2(18.9,22.0),干预前HbA1c 8.2% (6.7%,9.8%),41例(28.5%) HbA1c达标.完成3、6、9、12个月随访的患者分别为97、50、44、36例,HbA1c达标率分别为50.5%、80%、77%、63.9%.随访3、6、9、12个月HbA1c分别为7.2%(6.4%,8.3%)、7.2%(6.6%,7.9%)、7.0%(6.4%,7.7%)、7.0%(6.5%,8.0%),与干预前比较差异均有统计学意义(均P <0.05).Logistic回归分析显示年龄较大、BMI较小、自我血糖监测(SMBG)频率较高的和病程较短的患者血糖控制较好.结论 综合管理有助于T1 DM的血糖控制,增加自我血糖监测频率对血糖控制有利.
更多Objective To investigate the effect of disease-management programs on glycemic control in type 1 diabetic (T1DM) patients.Methods T1DM patients registered in the Third Affiliated Hospital of Sun Yat-sen University from August 6,2010 to January 1,2013 were enrolled and disease-management programs were implied in those patients,including scheduled follow-up every 3 months,diabetic education,treatment plan adjustment and free glycated hemoglobin A1c (HbA1c) test in each visit.The patients were divided into two groups according to the HbA1 c level:those whose HbA1 c reached the control standard and those not.Multivariate logistic regression analysis was used to investigate the correlative factors for control effect of HbA1c.Results Total of 144 T1DM patients were enrolled,among them 64 were male,80 were female,the patients aged 29.0 years (interquartile range:22.0,38.0,same below) with a T1DM duration of 4.5 years (2.8,9.0) and a body mass index (BMI) of 19.8 kg/m2 (18.9,22.0).The HbA1c at baseline was 8.2% (6.7%,9.8%) and 41 patients (28.5%) achieved the age-specific HbAlc targets after the therapy.The number of patients completed the 3-,6-,9-and 12-month follow-up was 97,50,44and 36,respectively.And of them,50.5%,80%,77%,63.9% reached the age-specific glycemic control goals at the 3-,6-,9-and 12-month visit,respectively.HbA1c fell from 8.2 (6.7%,9.8%) at baseline to7.2% (6.4%,8.3%) at3-month,7.2% (6.6%,7.9%) at6-month,7.0% (6.4%,7.7%) at9-month and 7.0% (6.5%,8.0%) at 12-month (all P < 0.05 compared with baseline).Binary logistic regression analysis showed that patients who were older,with lower BMI,more frequent self-monitoring of blood glucose(SMBG) and shorter diabetic duration had better glycemic control.Conclusions Diseasemanagement programs has a favorable effect on glycemic control in T1DM patients.Higher frequency of SMBG is beneficial for glycemic improvement.
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