钱敏+刘波+刘丰兵

摘 要 目的：观察家庭医生团队管理对社区2型糖尿病（T2DM）患者血糖控制的效果以及规范使用胰岛素的影响。方法：选择2013年10月至2014年9月已纳入社区糖尿病管理的300例使用胰岛素的糖尿病患者作为对象，将其随机分为观察组和对照组各150例。对照组给予糖尿病社区常规管理，观察组实行家庭医生团队管理，两组患者均干预1年，干预前后进行空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）测定，比较两组血糖控制情况以及胰岛素规范使用情况。结果：干预前两组FBG、2hPG、HbA1c差异均无统计学意义（P>0.05）。干预后观察组FBG、2hPG、HbA1c均较干预前明显降低（P<0.05）；对照组仅FBG较干预前明显降低（P<0.05）。与干预前相比，观察组干预后胰岛素使用规范情况明显提高，低血糖发生率明显降低，患者依从性明显提高，患者心脑血管并发症、糖尿病肾病、糖尿病眼部并发症发病率明显降低，差异均有统计学意义（P<0.01）。结论：家庭医生团队管理社区T2DM，有助于血糖水平的控制，规范胰岛素的使用，减少低血糖的发生，提高患者的依从性，减少糖尿病并发症的发生。

关键词 家庭医生团队 社区 糖尿病 胰岛素

中图分类号：R587.1 文献标识码：A 文章编号：1006-1533（2016）02-0040-03

Influence of the family doctor team management on the specification use of insulin in the community patients with type 2 diabetes

QIAN Min， LIU Bo， LIU Fengbing

（Changbai Community Health Service Center of Yangpu District， Shanghai 200093， China）

ABSTRACT Objective： To observe the effect of the family doctor team management on the blood glucose control of the community patients with type 2 diabetes （T2DM） and the influence on the specification use of insulin. Methods： Three hundred diabetic patients who used insulin in the community diabetic management from Oct. 2013 to Sept. 2014 were selected as the objects and randomly divided into an observation group and a control one with 150 cases each. The patients in the control group received the community regular management， while those in the observation one received the family doctor team management. The patients in both groups received the intervention for 1 year and the levels of fasting blood glucose （FBG）， 2 h postprandial blood glucose （2 hPG）， and glycosylated hemoglobin （HbA1c） were detected before and after the intervention in the two groups. The blood glucose control and the specification use of insulin were compared between two groups. Results： Before the intervention， the differences of the levels of FBG， 2 hPG， and HbA1c in the two groups had no statistical significance （P>0.05）. After the intervention， the levels of FBG， 2 hPG， and HbA1c in the observation group were reduced more significantly after than before the intervention （P<0.05）. In the control group only the level of FBG was reduced more significantly after than before the intervention （P<0.05）. Comparing the intervention before， the specification use of insulin was significantly enhanced， the incidence of hypoglycemia was significantly reduced， the patient compliance was significantly enhanced， and the incidence of the cardiovascular complications， diabetic nephropathy， and diabetic eye complications were significantly reduced in the observation group， and the differences had the statistical significance （P>0.01）. Conclusion： The family doctor team management of the community patients with T2DM can be conducive to the blood glucose control， specification use of insulin， reduction of the incidence of hypoglycemia， and improvement of the patients compliance so as to reduce the occurrence of the diabetic complication.

随着人民生活水平的提高，糖尿病的发病率呈逐年增长趋势，已成为临床的常见病、多发病，是引起心脑血管并发症的重要因素，是继肿瘤、心血管疾病之后导致死亡的第3大病因，对患者的身体健康及生命造成极大威胁[1]。注射胰岛素是糖尿病患者的治疗方法之一，随着胰岛素笔式注射器的使用，越来越多的糖尿病患者在社区家庭中自我注射胰岛素[2]。本文旨在观察家庭医生团队管理对社区糖尿病患者血糖控制的效果以及规范使用胰岛素的影响，现将结果分析如下。

1 资料与方法

1.1 一般资料

选择2013年10月至2014年9月已纳入本社区糖尿病管理的300例使用胰岛素的糖尿病患者作为研究对象，将其分为观察组150例和对照组150例。观察组中，男50例（33.33%），女100例（66.67%），年龄55～75岁，体重指数19.23～30.13 kg·m2，平均病程为（9.82±5.23）年。对……