奉贤东区糖尿病胰岛素类似物结构化管理初步探讨

黄国兰　李玢　杨卫红　季龙琴　金丹丹

【摘要】 目的：對奉贤东部地区糖尿病患者进行胰岛素类似物结构化管理模式的研究，以探讨胰岛素类似物结构化管理模式干预对奉贤区2型糖尿病患者血糖水平、行为和认知的影响，为区域性单病种高质量管理应用提供理论依据。方法：选取奉贤东部地区100例口服降糖药物但血糖依然控制不住的2型糖尿病患者，采用随机、平行对照临床研究方法，将患者随机分为结构化管理模式干预组（结构化管理模式）和对照组（常规医疗模式），各50例，两组均皮下注射诺和锐30。比较两组干预前后的糖化血红蛋白（HbA1c）、7点血糖谱、行为和认知改变评分、BMI和空腹C-肽（C-P）。结果：干预16周后，结构化管理模式干预组7点血糖谱、HbA1c均低于干预前及对照组（P<0.05），空腹C-P高于干预前、BMI低于干预前（P<0.05），但两组空腹C-P、BMI比较，差异均无统计学意义（P>0.05）;干预16周后，结构化管理模式干预组行为和认知评分均高于治疗前及对照组，差异均有统计学意义（P<0.05）。结论：使用诺和锐30治疗并接受结构化管理模式干预的2型糖尿病患者血糖、BMI控制效果更好，低血糖发生风险更低，患者行为和认知更好，对结构化管理模式在该区域的推广具有一定的指导意义。

【关键词】 2型糖尿病; 诺和锐30; 结构化管理; 奉贤东区

【Abstract】 Objective：To study the structured management model of insulin analogues in patients with diabetes mellitus in eastern Fengxian District，to explore the effects of the intervention of structured management model of insulin analogues on blood sugar level，behavior and cognition of type 2 diabetes mellitus in FengxianDistrict，so as to provide theoretical basis for the application of regional single disease high quality management.Method：A total of 100 patients with type 2 diabetes mellitus who took oral hypoglycemic drugs but still had uncontrollable blood sugar in eastern Fengxian District were selected.According to the randomized，parallel controlled clinical research method，they were randomly divided into structured management model intervention group（structured management model）and control group（conventional medical model），50 cases in each group，they were subcutaneously injected with Novoxel 30.The glycosylated hemoglobin（HbA1c），7-point blood glucose profile，behavioral and cognitive change score，BMI and fasting C-peptide（C-P）before and after intervention between two groups were compared.Result：After 16 weeks of intervention，the 7-point blood glucose profile and HbA1c instructured management model intervention group were lower than those of before intervention and control group（P<0.05），the fasting C-P was higher than that of before intervention，and the BMI was lower than that of before intervention（P<0.05），but the fasting C-P and BMI of two groups were compared，the differences were not statistically significant（P>0.05）.After 16 weeks of intervention，the behavioral and cognitive scores of structured management model intervention group were higher than those of before intervention and control group，the differences were statistically significant（P<0.05）.Conclusion：Patients with type 2 diabetes treated with Novotel 30 and intervened by structured management model，the control effect of blood sugar and BMI is better，the risk of hypoglycemia is lower，and patients behavior and cognition are better，it has certain guiding significance for the promotion of structured management model in this region.