| 共同照护模式下不同随诊频率对糖尿病患者的临床效果 |
| 投稿时间：2025-04-28 修订日期：2025-06-17 点此下载全文 |
| 引用本文：王美子,张春虹,徐静,权宁,张若,杨书珍,高欣桐,王佳敏,石浩璇.共同照护模式下不同随诊频率对糖尿病患者的临床效果[J].医学研究杂志,2025,54(11):72-77, 94 |
| DOI：
10.11969/j.issn.1673-548X.2025.11.014 |
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| 基金项目:陕西省重点研发计划项目(2023-YBSF-534) |
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| 中文摘要:目的 探讨在共同照护新模式下不同随诊频率对2型糖尿病(type 2diabetes mellitus, T2DM)患者各代谢终点的影响。方法 采用回顾性研究方法,选取2021年1月~2024年1月就诊于西安交通大学第二附属医院糖尿病共同照护门诊的985例T2DM患者,根据随诊频率不同将其分为较高频率随访组(HF组,n=500)和较低频率随访组(LF组,n=485),HF组患者随诊频率>2次/年,LF组患者随诊频率≤2次/年。比较随访前后两组间主要代谢指标的变化,采用Logistic回归进行亚组分析以评估不同患者特征对糖化血红蛋白(glycosylated hemoglobin, HbA1c)降低达标率(降低≥1%为达标)的影响,并计算达到各代谢终点的达标率。结果 平均随诊时间2.1±0.9年,两组患者的体重、腰围、臀围、腰臀比(waist-to-hip ratio,WHR)、HbA1c、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、总胆固醇(total cholesterol, TC)、估算肾小球滤过率(estimate glomerular filtration rate, eGFR)、尿微量白蛋白与肌酐比值(urinary albumin to creatinine ratio, UACR)比较,差异均有统计学意义(P＜0.05),其中HF组HbA1c、腰围降幅显著大于LF组(P＜0.001)。末次随访时,HF组达到中长期有效管理目标和综合代谢终点的患者比例高于LF组,尤其是HbA1c(62.40% vs 48.66%)。HF组与HbA1c降低达标率(降低≥1%)显著相关(OR＝2.130,95% CI:1.620~2.800,P＜0.001)。此外,采用Logistic回归进行亚组分析,结果显示,与达标率相关性最强的因素是初诊年龄≤50岁(OR＝2.650,95% CI:1.670~4.200,P<0.001)。结论 在共同照护新模式下,保持较高频率的随访(>2次/年,即平均随诊间隔＜146天)更有利于血糖和血脂的控制以及延缓肾功能的进行性减退。此外,在首次入组时应该针对不同特征的T2DM患者设计个性化的随诊计划,以实现高效率的分级诊疗。 |
| 中文关键词:2型糖尿病 共同照护门诊 代谢指标 规范化管理频率 |
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| Clinical Efficacy of Different Follow-up Frequencies on Type 2 Diabetes Mellitus Based on Shared Care Model. |
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| Abstract:Objective To explore the effect of different follow-up frequencies on various metabolic endpoints of patients with type 2diabetes mellitus (T2DM) based on shared care model. Methods A retrospective study was conducted on 985 patients with T2DM at the Second Affiliated Hospital of Xi′an Jiaotong University from January 2021 to January 2024. According to the different follow-up frequencies, the patients were divided into high-frequency (HF group, n=500) and low-frequency (LFgroup, n=485) follow-up groups, the follow-up frequency of patients in the HF group was >2 times/year, and that of patients in the LF group was ≤2 times/year. The changes of main metabolic indicator between the two groups before and after follow-up were compared, Logistic regression was used for subgroup analysis to evaluate the impact of different patient characteristics on the compliance rates of glycosylated hemoglobin (HbA1c) reduction (≥1% reduction), and the compliance rates reaching each metabolic endpoints was also calculated. ResultsAfter a follow-up of 2.1±0.9 years, there were significant differences between two groups in weight, waist circumference, hip circumference, waist-to-hip ratio (WHR), HbA1c, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), estimate glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR) (P<0.05). The HF group showed greater reductions in HbA1c and waist circumference than the LF group (P<0.001). At the last follow-up, the proportion of patients in the HF group achieving the medium and long-term effective management goals and the comprehensive metabolic endpoints was higher than that in the LF group, especially for HbA1c (62.40% vs 48.66%). The HF group was significantly associated with the compliance rates of HbA1c reduction (reduction ≥1%) (OR=2.130,95% CI:1.620-2.800, P<0.001). In addition, Logistic regression was used for subgroup analyses, the results indicated that an initial diagnosis age ≤ 50 years was the strongest factor associated with compliance rates (OR=2.650,95% CI:1.670-4.200, P<0.001). Conclusion Under the shared care model, a higher follow-up frequency (>2 times/year, that is, <146day intervals) improves glycemic and lipid control and delays renal function progression. In addition, personalized follow-up plans for T2DM patients with different characteristics at the time of the first enrollment can achieve efficient hierarchical diagnosis and treatment. |
| keywords:Type 2diabetes mellitus Shared care clinic Metabolic indicators Standard management frequency |
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