Zarora Reetu, MacMillan Freya, Piya Milan K, Fernandes Brunelle, Simmons David
Macarthur Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
Diabetes Obesity and Metabolism Translational Research Unit, The Translational Health Research Institute, Sydney, New South Wales, Australia.
Intern Med J. 2022 Jun;52(6):975-981. doi: 10.1111/imj.15211. Epub 2022 May 31.
Diabetes management often requires close cooperation between primary and specialist services, but a range of challenges in Australia and elsewhere make seamless care difficult.
To evaluate the effectiveness of a new locality-based integrated diabetes care service for people with Type 2 diabetes in an inner regional area.
A quasi-experimental evaluation comparing baseline and follow-up clinical data collected from general practices and specialist services participating in an integrated diabetes care programme in an inner-regional area. Patients had at least one specialist service consultation. The primary outcome was glycated haemoglobin (HbA1c).
Clinical data were collected for 178 (74.5%) of 239 patients (age ± standard deviation, 65 ± 11 years; 46% female; median (interquartile range) diabetes duration, 19 (11.0-24.0) years) from seven general practices over 33 months (median 18.5 months). There were reductions in HbA1c (0.7 ± 1.6% (8 ± 18 mmol/mol); P < 0.001), systolic blood pressure (5.8 ± 19.5 mmHg; P < 0.001), diastolic blood pressure (2.4 ± 14.3 mmHg; P = 0.04), total cholesterol (0.5 ± 1.3 mmoL/L; P < 0.001), low-density lipoprotein (0.4 ± 0.9 mmoL/L; P < 0.001), body mass index (0.5 ± 1.6 kg/m ; P < 0.001) and weight (1.8 ± 4.7 kg; P < 0.001). The proportion without microalbuminuria increased from 48.4% to 59.3% (P = 0.03).
Glycaemia and cardiovascular risk factors can be reduced in patients with long-standing Type 2 diabetes by moving to a locality-based integrated primary-secondary care diabetes care service.
糖尿病管理通常需要基层医疗服务和专科医疗服务之间密切合作，但在澳大利亚及其他地区，一系列挑战使得无缝护理难以实现。
评估一种针对内城区2型糖尿病患者的新型基于社区的综合糖尿病护理服务的有效性。
进行一项准实验性评估，比较从参与内城区综合糖尿病护理项目的全科医疗和专科医疗服务机构收集的基线和随访临床数据。患者至少接受过一次专科医疗服务咨询。主要结局指标是糖化血红蛋白（HbA1c）。
在33个月（中位数18.5个月）内，从7家全科医疗诊所收集了239例患者中178例（74.5%）的临床数据（年龄±标准差，65±11岁；46%为女性；糖尿病病程中位数（四分位间距），19（11.0 - 24.0）年）。糖化血红蛋白降低（0.7±1.6%（8±18 mmol/mol）；P<0.001），收缩压降低（5.8±19.5 mmHg；P<0.001），舒张压降低（2.4±14.3 mmHg；P = 0.04），总胆固醇降低（0.5±1.3 mmol/L；P<0.001），低密度脂蛋白降低（0.4±0.9 mmol/L；P<0.001），体重指数降低（0.5±1.6 kg/m²；P<0.001），体重降低（1.8±4.7 kg；P<0.001）。无微白蛋白尿的比例从48.4%增至59.3%（P = 0.03）。
对于长期2型糖尿病患者，转向基于社区的基层 - 二级综合糖尿病护理服务可降低血糖水平及心血管危险因素。
