Mathur Ruchi, Roybal G Michael, Peters Anne L
Division of Endocrinology, USC Keck School of Medicine, Los Angeles, CA, USA.
Curr Med Res Opin. 2005 Dec;21(12):1935-41. doi: 10.1185/030079905X75014.
We developed a Diabetes Management Program (DMP) located within a county health center for poor, primarily Latino patients. The purpose of this study is to document if our program can achieve global risk reduction in our population, and whether or not this improvement can be sustained through on-going follow-up in primary care.
This is an observational study, using a database into which patient information is entered weekly. Information from the database is used to compare patients at baseline, at discharge from the program and then after a year or more of follow-up in primary care.
Change in A1C, low density lipoprotein (LDL) cholesterol, blood pressure (BP) levels; use of cardiovascular disease (CVD) modifying medications.
171 patients had data available at baseline, discharge and annual follow-up. Baseline A1C is 8.5 +/- 1.9% (mean +/- SD), with a fall to 7.4 +/- 1.2% (p < 0.001) at discharge. After 1 year in primary care the A1C increased back to baseline (8.3 +/- 1.7%), without change in diabetes medications. LDL cholesterol and BP levels are reduced by discharge, and these improvements persisted at the annual follow-up. Additionally, patients continued with CVD risk modifying therapy (statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, aspirin) at their annual visits. Limitations to this study include the small number of patients who returned for their annual examination, the lack of a matched control group for comparison and the use of an existing database.
Persistent change in CVD risk factors can be made through diabetes disease management; changes in glucose control, however, are more difficult to sustain in spite of continued use of medication. Further research must be undertaken to help improve glycemic outcomes over time.
我们在一家县卫生中心为贫困的主要是拉丁裔患者开发了一个糖尿病管理项目（DMP）。本研究的目的是记录我们的项目是否能在我们的人群中实现整体风险降低，以及这种改善是否能通过初级保健中的持续随访得以维持。
这是一项观察性研究，使用一个每周录入患者信息的数据库。数据库中的信息用于比较患者在基线、项目出院时以及在初级保健中随访一年或更长时间后的情况。
糖化血红蛋白（A1C）、低密度脂蛋白（LDL）胆固醇、血压（BP）水平的变化；心血管疾病（CVD）改善药物的使用情况。
171名患者在基线、出院时和年度随访时有可用数据。基线时A1C为8.5±1.9%（均值±标准差），出院时降至7.4±1.2%（p<0.001）。在初级保健一年后，A1C回升至基线水平（8.3±1.7%），糖尿病药物使用情况无变化。LDL胆固醇和BP水平在出院时降低，这些改善在年度随访时持续存在。此外，患者在年度就诊时继续接受CVD风险改善治疗（他汀类药物、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、阿司匹林）。本研究的局限性包括返回进行年度检查的患者数量较少、缺乏匹配的对照组进行比较以及使用现有数据库。
通过糖尿病疾病管理可使CVD风险因素持续改变；然而，尽管持续用药，血糖控制的变化更难维持。必须进行进一步研究以随着时间推移帮助改善血糖结局。
