徐婕+洪都+戴丽学+等

[摘要] 目的 探讨社区个案管理模式的运用对长期血糖控制不佳的2型糖尿病患者（T2DM）自我管理水平及生存质量的影响。 方法 采用随机对照试验（RCT）研究，将2013年6～12月在湖州市第一人民医院确诊的飞英街道社区2型糖尿病患者105例按随机数字表法随机分为干预组（53例）和对照组（52例）。干预组在常规护理基础上接受6个月的社区个案管理干预，对照组接受常规管理和护理。干预前及干预6个月后检测并比较两组患者糖化血红蛋白（HbA1C）和空腹血糖水平；采用中文版糖尿病自我管理行为量表（SDSCA）评价两组患者自我管理水平并进行比较。 结果 干预6个月后两组患者HbA1C水平和空腹血糖变化差异无统计学意义（P>0.05），但基线水平较干预前均有下降。两组患者在饮食控制、运动锻炼、血糖监测、用药安全等自我管理行为方面的差异有统计学意义（P<0.05），干预组优于对照组。 结论 社区糖尿病个案管理模式不仅对T2DM患者的血糖和HbA1C控制有一定的作用，可以显著改善其自我管理水平，提高其生存质量。

[关键词] 个案管理；2型糖尿病；社区卫生服务；健康教育；自我管理

[中图分类号] R473.2 [文献标识码] B [文章编号] 1673-9701（2015）25-0132-05

Effect of community case management model in patients with type 2 diabetes mellitus

XU Jie1 HONG Du2 DAI Lixue1 SHEN Huaying1 ZHANG Liying1 NI Lin1

1.Department of Endocrinology， Huzhou First people's Hospital in Zhejiang Province， Huzhou 313000， China； 2.Department of Nursing， Huzhou University in Zhejiang Province， Huzhou 313000，China

[Abstract] Objective To evaluate the effect of community case management model（CCMM） on quality of life and self-management ability in type 2 diabetes patients with poor control of blood glucose. Methods Totally 105 patients in feiying street community diagnosed with type 2 diabetes by Huzhou First people's Hospital were randomly divided into two groups（experimental group： n=53； control group： n=52）. The patients in the control group received routine diabetes management and nursing，while the patients in the experimental group received community case management model intervention. Before intervention and six months after intervention， HbA1C level and fasting blood-glucose of two groupspatients were checked and compared. Chinese version scale of the diabetes self-care activities（SDSCA） were used to evaluated self-management ability and quality of life. Results There was no significant difference in HbA1C level and fasting blood glucose level between the two groups after 6 months of intervention （P>0.05）， but the baseline level was decreased. In the two groups of patients in the diet control， exercise， blood glucose monitoring， drug safety and other self management behavior differences were statistically significant（P<0.05）， the intervention group was better than the control group. Conclusion CCMM intervention is more effective than routine diabetes management and nursing on the improvement of self-management ability and quality of life in type 2 diabetes patients with poor control of blood glucose.

[Key words] Case management； Type 2 diabetes mellitus （T2DM）； Community health services； Health education； Self-management

据统计，糖尿病（diabetes mellitus，DM）患病人数正逐年增加，其中以T2DM人数居多，且T2DM的增长速度远高于T1DM[1]。T2DM会严重影响患者的身体健康和生存质量，而且会加重家庭和社会的负担。因此，探讨出一种适合T2DM有效的干预模式非常重要，有助于控制和减轻其不良危害[2]。个案管理模式（case management model，CMM）源于保险行业，其长期有效的运行程序不断被学者引用到医学领域应用于慢性病种的长期管理。美国护理协会（ANA）将其定义为“提供给特定的人群并协调其医疗护理服务”的一种管理模式。个……