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本文研究是以综合医院内分泌专科医护人员为主体服务于糖尿病人,目的是希望管理好糖尿病患者。方法:选择2008年2～4月期间就诊的门诊及住院部2型糖尿病220例,分成新发2型糖尿病组,2型糖尿病组,给予①糖尿病教育讲座;②专科护士每月一次电话随访并交代复诊及注意事项;③管理人员每2月一次通知病人到院义诊,听讲座;④监测指标:糖化血红蛋白、血糖血脂、血压、身高、体重、腰围、尿微量白蛋白、心电图、血管彩超、眼底镜检查;⑤以上管理方式坚持3年。结果:两组病例3年来能坚持者约占25%,其中新发2型糖尿病组为25.3%,2型糖尿病组为26.3%。结论:较强的内分泌专科医护团队在医院单方面努力仅25%患者可能取得糖尿病良好控制,而另75%专科医生可能会失败。良好的糖尿病管理应以病人为中心,社区上门服务,专科医生指导,政府部门全力支持。
This article is based on comprehensive hospital endocrine specialist nurses serving the diabetic as the main purpose is to manage the diabetic patients. Methods: Two hundred and twenty cases of outpatients and inpatients with type 2 diabetes during the period from February to April in 2008 were divided into new type 2 diabetes mellitus group and type 2 diabetes mellitus group. Diabetes education lecture was given. (2) Monthly nurse specialist calls were followed up Explain the referral and pay attention to matters; (3) Management once every two months to inform the patient to hospital Yi clinic, listen to lectures; monitoring indicators: glycosylated hemoglobin, blood glucose, blood pressure, height, weight, waist circumference, urine microalbumin, electrocardiogram, Fundus examination; ⑤ adhere to the above management methods for 3 years. Results: The two groups of patients adhere to about 25% in three years, of which 25.3% in newly diagnosed type 2 diabetes and 26.3% in type 2 diabetes mellitus. CONCLUSIONS: A strong endocrine specialist team in unilaterally working at a hospital may achieve good diabetes control in only 25% of patients, while another 75% may fail. Good diabetes management should be patient-centered, community-based services, specialist guidance, government departments full support.