不同病程的2型糖尿病患者经标准化代谢性疾病管理后的代谢指标转归

来源 :中华内分泌代谢杂志 | 被引量 : 0次 | 上传用户:ZHANGYJ000
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目的:探讨不同病程的2型糖尿病患者在接受标准化代谢性疾病管理1年后,其糖脂代谢相关指标转归及达标情况。方法:(1)将2017年9月至2018年9月在上海市第一人民医院国家标准化代谢性疾病管理中心(MMC)的345例2型糖尿病患者纳入研究,根据患者病程,分为新诊断2型糖尿病组(病程≤1年)和长病程组(病程>1年),比较2组患者基线时一般情况、血压、血糖、血脂水平及其达标率,以及综合达标率(血糖、血压和血脂三项均达标);(2)所有患者均接受标准化代谢性疾病管理,比较治疗1年后上述代谢指标的转归及达标情况。结果:(1)基线时,与长病程组相比,新发糖尿病组患者更年轻(n P<0.01),糖负荷后2 h血糖水平较高[(15.20±5.26对13.68±4.94) mmol/L,n P<0.01]。(2)经过1年标准化代谢性疾病管理后,总体体重、血压及糖脂代谢指标均显著改善。相较于长病程组,新发糖尿病组患者血糖控制更好[空腹血糖(6.27±1.56对7.63±2.08) mmol/L,n P<0.01;糖化血红蛋白(6.33±0.96对7.23±1.37) %,n P<0.01],且HOMA-β较高[(74.01±56.45对40.17±37.07) %,n P<0.01]。两组患者血糖、血压、血脂达标率均明显上升,整体综合达标率由5.80%上升至24.06%,经过1年治疗后,与长病程组相比,新发糖尿病组患者综合达标率更高(24.73%对17.18%,n P=0.087);血糖达标率84.62%对53.37%(n P1 year). The general characteristics, blood pressures, glycemic levels, lipids levels, control rates and comprehensive compliance rates(blood glucose, pressure and lipids all reached targets) were compared at baseline between 2 groups.(2)All patients underwent one year standardized management, and metabolic indicators mentioned above and control rates at the time were compared as well.Results:(1) At baseline, compared with long-term group, patients in newly-diagnosed type 2 diabetes group were younger (n P<0.01), and 2 h blood glucose level after glucose loading were higher [(15.20±5.26n vs 13.68±4.94) mmol/L, n P<0.01]. (2) After one year standardized management, body weight, blood pressure, glucose and lipids metabolism in all patients were significantly improved. Compared with patients in long-term group, newly-diagnosed type 2 diabetes patients achieved better glycemic level [fasting blood glucose(6.27±1.56n vs 7.63±2.08) mmol/L, P<0.01; glycated hemoglobin(6.33±0.96n vs 7.23±1.37) %, n P<0.01] , and had higher HOMA-β [(74.01±56.45n vs 40.17±37.07) %, n P<0.01]. The glycemic control, blood pressure and blood lipids control rates in both groups increased significantly in one year. Comprehensive compliance rate of the whole patients increased from 5.80% to 24.06%. The metabolism indexes of the newly-diagnosed type 2 diabetes group were better than those of the long-term group[comprehensive compliance rate: (24.73%n vs 17.18%, n P=0.087, glycemic control rate(84.62% n vs 53.37%, n P<0.01)].n Conclusion:Standardized metabolic disease management promoted the overall improvement in blood glucose, blood pressure, and lipids levels in type 2 diabetes patients, especially in terms of blood glucose and those of the newly-diagnosed type 2 diabetes. In the future, we should focus on the early diagnosis and treatment of type 2 diabetes, actively promote the MMC model and stress the integrated management of blood glucose, blood pressure, and blood lipid levels. We should pay more attention to the long-term patients, to improve their awareness and treatment compliance.
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