Li Jin, Huang Bin, Wang Shengyan, Ji Xudong, Yin Jianxin, Yang Naihong, Zhai Junxia, Kang Wenhuan, Ma Xuhong
Department of Internal Medicine, Jimusar Traditional Chinese Medicine Hospital, Changji 831700, Xinjiang Uygur Autonomous Region, China.
Xiamen Medical College, Xiamen 361023, Fujian, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1497-1500. doi: 10.3760/cma.j.issn.2095-4352.2019.12.012.
To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions.
Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin II receptor blocker (ACEI/ARB) were collected.
A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05].
Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
探讨“糖尿病专科医生 - 社区全科医生 - 社区护士共同管理模式”与“糖尿病专科医生管理模式”对基层医疗机构糖尿病肾病（DN）的影响。
选取2017年10月至2018年3月在新疆维吾尔自治区吉木萨尔县泉子街镇卫生院收治的2型糖尿病患者。根据患者所在行政村将其分为共同管理组和专科管理组。两组治疗方案均参照现行指南制定。共同管理组由吉木萨尔县中医医院糖尿病专科医生、泉子街镇卫生院社区全科医生和社区护士组成的固定团队进行联合管理，且要求每月参加糖尿病教育课程。吉木萨尔县中医医院糖尿病专科医生负责研究对象治疗方案的制定与管理。两组均每4周随访1次，共随访２４周。干预前后收集血糖、血压、尿白蛋白/肌酐比值（UACR）、估算肾小球滤过率（eGFR）以及血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂（ACEI/ARB）的使用率。
共有115例患者完成本研究，其中共同管理组54例，专科管理组61例。干预24周后，共同管理组和专科管理组的空腹血糖水平、早餐后2小时餐后血糖水平、糖化血红蛋白（HbA1c）、Log UACR较基线均显著降低[空腹血糖水平（mmol/L）：8.06±1.92比9.16±2.83，8.21±2.10比9.06±1.89；早餐后2小时餐后血糖水平（mmol/L）：12.26±3.78比14.11±5.28，12.47±3.63比14.00±3.88；HbA1c：0.074±0.014比0.082±0.023，0.076±０.０14比0.081±0.016；Log UACR（mg/g）：1.63±1.56比2.25±1.44，1.84±1.65比2.43±1.56，均P<0.05]，但两组间比较差异无统计学意义[空腹血糖水平（mmol/L）：-1.10±0.47比-0.85±0.36，早餐后2小时餐后血糖水平（mmol/L）：-1.85±0.88比-1.53±0.68，HbA1c：-0.008±0.004比-0.006±0.003，Log UACR（mg/g）：-0.61±0.29比-0.59±0.29，均P>0.05]。两组干预前后血压、血清肌酐和eGFR无明显变化。共同管理组和专科管理组分别有18例和24例高血压患者。两组干预后ACEI/ARB使用率均显著高于干预前[88.9%（16/18）比22.2%（4/18），95.8%（23/24）比29.2%（7/24），均P<0.01]。研究结束时，两组ACEI/ARB使用率相近[88.9%（16/18）比95.8%（23/24），P>0.05]。
“糖尿病专科医生 - 社区全科医生 - 社区护士共同管理模式”与“糖尿病专科医生管理模式”均可有效降低2型糖尿病患者的血糖水平和UACR水平，并规范降压药物的使用，对DN的防治具有积极作用。
