基于床边血糖数据调整管理策略对住院糖尿病患者血糖管理质量的影响

发布时间：2018-05-25 21:41

本文选题：糖尿病 + 血糖管理　；参考：《南方医科大学》2017年硕士论文

【摘要】：目的:评价基于医院床边血糖监测系统(BGMS)数据调整血糖管理策略,对改善住院糖尿病患者血糖管理质量的价值。方法:对2008-2011和2014-2015年在内分泌科住院的3432例次和1292例次糖尿病患者及其196781次和64330次的BGMS血糖数据,采用Population(群体模型)、Patient(个体模型)、Patient-day(人时模型)及质量血糖评分模型(QHS)等多种血糖评价模型进行分析和比较。结果:基于2008-2011年BGMS血糖数据分析结果,2013年开始对血糖监测方式、睡前血糖目标等血糖管理策略进行调整后,与2008-2011年相比,2014-2015年住院糖尿病患者:①患者平均住院天数减少0.95天(10.62±6.69vs 11.57±6.62,p0.001),人均监测血糖减少 7.55次(49.79±27.94 vs 57.34±31.31,p0.001),患者日均监测血糖减少0.43次(5.05±2.00 vs 5.48±2.05,p0.001);②凌晨、午餐前等低血糖高发时间段的血糖监测次数分别增加 32.11%(11.72%vs 8.71%,p0.001)和 12.15%(11.72%vs 10.45%,p0.001),而午餐后、晚餐后等低血糖低发时间段的血糖监测次数则明显减少(p0.05);③低血糖和严重低血糖事件频次分别减少7.63%(1.09%vs 1.18%,p=0.051)和18.75%(0.13%vs 0.16%,p=0.073);发生低血糖和严重低血糖的患者比例分别下降13.37%(27.01%vs 31.18%,p=0.005)和 33.48%(4.65%vs 6.99%,p=0.003);低血糖和严重低血糖的患者-住院日分别减少 14.16%(4.97%vs 5.79%,p=0.001)和 24.71%(0.64%vs 0.85%,p=0.020);反复发生低血糖(3次)患者占总患者比例降低37.14%(2.86%vs 4.55%,p=0.009);④午餐前、午餐后、晚餐前、睡前时段的低血糖发生密度分别下降32.98%(1.26%vs 1.88%,p0.001)、44.29%(0.39%vs 0.70%,p=0.004)、32.53%(0.56%vs 0.83%,p=0.007)和 36.96%(0.58%vs 0.92%,p=0.001),早餐后、午餐前、午餐后、晚餐前及睡前时段发生低血糖的患者占比分别下降25.83%(5.11%vs 6.89%,p=0.027)、29.89%(6.59%vs 9.40%,p=0.003)、57.29%(1.67%vs 3.91%,p0.001)、29.05%(4.20%vs 5.92%,p=0.021)和 36.99%(4.19%vs 6.65%,p=0.002);⑤相较于住院前期(入院前3天),住院后期(入院3天后)在低/高血糖程度及血糖波动等方面的改善更为明显,QHS评分改善幅度增加;⑥凌晨、早餐前及午餐前时段仍是低血糖的高发时间段,午餐后和睡前时段仍是严重高血糖的高发时间段;⑦出现严重高血糖事件的患者比例与前相仿,但严重高血糖事件及其患者-住院日分别增加11.82%(8.61%vs 7.70%,p0.001)和 8.16%(24.51%vs 22.66%,p0.001);⑧ 1 型糖尿病及老年(≥60岁)患者的低血糖发生率较高,低血糖减少更多见于2型糖尿病、非老年人(≤59岁)及男性患者。结论:充分利用信息化BGMS数据,定期分析评价临床血糖管理效果,寻找血糖控制相关影响因素,改进和调整临床血糖管理策略,可显著改善住院糖尿病患者血糖管理质量。
[Abstract]:Objective: To evaluate the value of adjusting blood glucose management strategy based on hospital bedside blood glucose monitoring system (BGMS) data to improve the quality of blood glucose management in hospitalized diabetic patients. Methods: 3432 cases in the 2008-2011 and 2014-2015 years in the Department of Endocrinology and 1292 cases of diabetes mellitus and their 196781 and 64330 blood glucose data, using Populat The ion (group model), the Patient (individual model), the Patient-day (human time model) and the mass glucose score model (QHS) were analyzed and compared. Results: Based on the results of the 2008-2011 year BGMS blood glucose data analysis, the blood glucose management strategies, such as blood glucose monitoring formula and bedtime blood glucose target, were adjusted in 2013, and 2008-2 Compared with 011 years, 2014-2015 years of hospitalized diabetic patients: (1) the average hospitalization days were reduced by 0.95 days (10.62 + 6.69vs 11.57 + 6.62, p0.001), and the per capita blood sugar decreased by 7.55 times (49.79 + 27.94 vs 57.34 + 31.31, p0.001). The number of blood glucose monitoring times increased by 32.11% (11.72%vs 8.71%, p0.001) and 12.15% (11.72%vs 10.45%, p0.001), while after lunch, the number of blood glucose monitoring times decreased significantly (P0.05), and the frequency of hypoglycemia and severe hypoglycemia decreased by 7.63% (1.09%vs 1.18%, p=0.051) and 18.75% (0.13) after lunch. %vs 0.16%, p=0.073); the proportion of patients with hypoglycemia and severe hypoglycemia decreased by 13.37% (27.01%vs 31.18%, p=0.005) and 33.48% (4.65%vs 6.99%, p=0.003); patients with hypoglycemia and severe hypoglycemia were reduced by 14.16% (4.97%vs 5.79%, p=0.001) and 24.71% (0.64%vs 0.85%, p=0.020), and recurrent hypoglycemia (3 times). The proportion of total patients was reduced by 37.14% (2.86%vs 4.55%, p=0.009); (4) before lunch, before dinner, before dinner, the density of hypoglycemia decreased by 32.98% (1.26%vs 1.88%, p0.001), 44.29% (0.39%vs 0.70%, p=0.004), 32.53% (0.56%vs 0.83%, p= 0.007) and 36.96% (0.58%vs 0.92%, p=0.001), after breakfast, lunch, dinner before and before dinner, and Patients with hypoglycemia during the time of bedtime were reduced by 25.83% (5.11%vs 6.89%, p=0.027), 29.89% (6.59%vs 9.40%, p=0.003), 57.29% (1.67%vs 3.91%, p0.001), 29.05% (4.20%vs 5.92%, p=0.021) and 36.99% (4.19%vs 6.65%, p=0.002), compared to the early hospitalization (3 days before admission) and low / high blood sugar levels in the late hospitalization (hospitalized days after admission) and The improvement in blood glucose fluctuations was more obvious, and the QHS score was improved. 6. In the early hours of the morning, before and before lunch, the high incidence of hypoglycemia was still a high time period of high blood sugar after lunch and bedtime; and the proportion of patients with severe hyperglycemia was similar to those of the former, but the serious hyperglycemia events and their suffering were The hospitalization days increased by 11.82% (8.61%vs 7.70%, p0.001) and 8.16% (24.51%vs 22.66%, p0.001), and the incidence of hypoglycemia in patients with type 1 diabetes and old age (> 60 years old) was higher, and hypoglycemia decreased more in type 2 diabetes, non elderly (less than 59 years) and male patients. Conclusion: the information of information BGMS is fully utilized and periodic analysis of evaluation is made. In order to improve and adjust the clinical blood glucose management strategy, the quality of blood glucose management in hospitalized diabetic patients can be improved significantly.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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