中国社区糖尿病与抑郁症患者综合照护（CIC-PDD）的效果：一项实用性整群随机试验

Effect of Community-Based Integrated Care for Patients With Diabetes and Depression (CIC-PDD) in China: A Pragmatic Cluster-Randomized Trial.

作者信息

Wang Yanshang, Guo Dan, Xia Yiqi, Hu Mingzheng, Wang Ming, Yu Qianqian, Li Zhansheng, Zhang Xiaoyi, Ding Ruoxi, Zhao Miaomiao, Shi Zhenyu, Zhu Dawei, He Ping

机构信息

School of Public Health, Peking University, Beijing, China.

China Center for Health Development Studies, Peking University, Beijing, China.

出版信息

Diabetes Care. 2025 Feb 1;48(2):226-234. doi: 10.2337/dc24-1593.

DOI:10.2337/dc24-1593

PMID:39680474

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11770166/

Abstract

OBJECTIVE

To develop a care model for patients with both diabetes and depression and assess the model's effectiveness.

RESEARCH DESIGN AND METHODS

In this pragmatic cluster randomized trial, we allocated eight community health centers into two groups: the enhanced usual care group and the intervention group. A comprehensive care plan was developed for the intervention group based on the integrated care model. We recruited individuals aged ≥18 years with type 2 diabetes and depression (Patient Health Questionnaire-9 score ≥10). The primary outcome was the between-group difference in the percentage of patients who had at least a 50% reduction in depressive symptoms and a reduction of at least 0.5 percentage points in HbA1c. The outcome analysis was conducted within the intention-to-treat population; missing data were multiply imputed.

RESULTS

We enrolled 630 participants, with 275 in the intervention group and 355 in the control group. A significantly greater percentage of patients in the intervention group met the primary outcome at 12 months (for depressive symptoms: risk difference [RD] 31.03% [62.06% vs. 31.02%, respectively; 95% CI 21.85-40.21]; for HbA1c: RD 19.16% [32.41% vs. 13.25%, respectively; 95% CI 11.35-26.97]). The patients in the intervention group showed significant enhancements in mental quality of life (mean difference [MD] 6.74 [46.57 vs. 39.83, respectively; 95% CI 3.75-9.74]), diabetes self-care activities (MD 0.69 [3.46 vs. 2.78, respectively; 95% CI 0.52-0.86]), medication adherence (MD 0.72 [6.49 vs. 5.78, respectively; 95% CI 0.37-1.07]), and experience of care (MD 0.89 [3.84 vs. 2.95, respectively; 95% CI 0.65-1.12]) at 12 months. Rural participants benefited more from the intervention.

CONCLUSIONS

The implementation strategy can serve as a valuable blueprint for the identification and treatment of patients with physical and mental multimorbidity in primary health care settings.

摘要

目的

建立一种针对糖尿病和抑郁症患者的护理模式，并评估该模式的有效性。

研究设计与方法

在这项实用性整群随机试验中，我们将8个社区卫生中心分为两组：强化常规护理组和干预组。基于综合护理模式为干预组制定了全面的护理计划。我们招募了年龄≥18岁的2型糖尿病合并抑郁症患者（患者健康问卷-9评分≥10）。主要结局是两组中抑郁症状至少减轻50%且糖化血红蛋白（HbA1c）降低至少0.5个百分点的患者百分比之间的差异。结局分析在意向性治疗人群中进行；缺失数据采用多重填补法处理。

结果

我们纳入了630名参与者，其中干预组275名，对照组355名。干预组中在12个月时达到主要结局的患者百分比显著更高（抑郁症状：风险差异[RD]31.03%[分别为62.06%和31.02%；95%置信区间21.85 - 40.21]；HbA1c：RD 19.16%[分别为32.41%和13.25%；95%置信区间11.35 - 26.97]）。干预组患者在12个月时的心理生活质量（平均差异[MD]6.74[分别为46.57和39.83；95%置信区间3.75 - 9.74]）、糖尿病自我护理活动（MD 0.69[分别为3.46和2.78；95%置信区间0.52 - 0.86]）、药物依从性（MD 0.72[分别为6.49和5.78；95%置信区间0.37 - 1.07]）以及护理体验（MD 0.89[分别为3.84和2.95；95%置信区间0.65 - 1.12]）均有显著改善。农村参与者从干预中获益更多。