2型糖尿病管理八年联合达标对心血管事件及全因死亡的影响研究
发布时间：2019-03-09 10:50
【摘要】：目的探讨2型糖尿病(T2DM)管理八年联合达标对心血管事件及全因死亡的影响。方法在北京社区糖尿病研究(BCDS)课题内,以劲松社区441例T2DM患者为研究对象,患者入选时间为2008年8—12月,随访至2016年9月,无脱落病例。采用随机数字表法,将纳入患者分为强化管理组(n=220)和标准管理组(n=221)。两组患者均由全科医师在三级甲等医院专家指导下进行"一对一"管理,定期随访及监测各项指标,及早发现并发症并进行干预。两组患者的管理差异主要为随访周期及重要指标的检测频率不同:强化管理组患者每2个月随访1次,糖化血红蛋白(Hb A1c)每3个月检测1次、尿微量清蛋白排泄率(UAER)每6个月检测1次;标准管理组患者每3个月随访1次,Hb A1c每6个月检测1次、UAER每年检测1次。比较两组患者2008—2016年各代谢指标达标率及联合达标率、终点事件发生率,分析联合达标次数对心血管事件及全因死亡的影响。结果强化管理组患者2012年空腹血糖(FPG)达标率低于标准管理组,2015—2016年FPG、Hb A1c、低密度脂蛋白胆固醇(LDL-C)达标率及联合达标率高于标准管理组,2015年血压达标率高于标准管理组,差异有统计学意义(P0.05)。两组患者2008—2016年全因死亡、脑血管事件、心血管事件、糖尿病肾病、糖尿病视网膜病变、周围血管事件、肿瘤发生率及总终点事件发生率比较,差异无统计学意义(P0.05)。共139例(31.5%)患者联合达标次数≥3次,余302例(68.5%)联合达标次数3次。联合达标次数≥3次患者全因死亡、心血管事件发生率及总终点事件发生率低于联合达标次数3次患者,差异有统计学意义(P0.05)。经Log-rank检验,联合达标次数≥3次患者全因死亡、心血管事件累积风险低于联合达标次数3次患者,差异有统计学意义(P0.05)。管理第6年,联合达标次数≥3次患者的全因死亡、心血管事件发生率低于联合达标次数3次患者,差异有统计学意义(P0.05)。结论社区医院与三级甲等医院联合精细管理可有效提高T2DM患者的联合达标率,联合达标次数≥3次患者的全因死亡和心血管事件发生率在管理第6年明显降低。
[Abstract]:Objective to investigate the effects of 8-year management of type 2 diabetes mellitus (T2DM) on cardiovascular events and all-cause death. Methods A total of 441 T2DM patients from Jinsong community were selected as subjects in the (BCDS) study of Beijing community diabetes mellitus. The patients were followed up from August to December of 2008 and followed up to September 2016. There were no shedding cases. The patients were divided into two groups: intensive management group (n = 220) and standard management group (n = 221). The patients in both groups were managed by general practitioners under the guidance of experts in Grade 3A Hospital, followed up and monitored regularly, complications were detected as soon as possible and intervention was carried out. The difference in management between the two groups was mainly in the follow-up period and the frequency of detection of important indicators: the patients in the intensive management group were followed up every 2 months, and the Hb A1c was detected every 3 months. Urinary albumin excretion rate (UAER) was detected every 6 months. The patients in the standard management group were followed up every 3 months, Hb A1c was tested every 6 months, and UAER was detected once a year. The rate of reaching the standard and the rate of combined reaching the standard and the incidence of the end-point events were compared between the two groups from 2008 to 2016. The effects of the times of the combination reaching the standard on cardiovascular events and all-cause death were analyzed. Results in the intensive management group, the level of fasting blood glucose (FPG) in 2012 was lower than that in the standard management group. In 2015-2016, FPG,Hb A1c, low density lipoprotein cholesterol (LDL-C) and combined rate were higher than those in the standard management group. The blood pressure reached the standard rate in 2015 was higher than the standard management group, the difference was statistically significant (P0.05). All-cause deaths, cerebrovascular events, cardiovascular events, diabetic nephropathy, diabetic retinopathy, peripheral vascular events, tumor incidence and total endpoint events were compared between the two groups from 2008 to 2016. There was no significant difference (P0.05). 139 patients (31.5%) achieved the standard more than 3 times, the remaining 302 patients (68.5%) achieved the standard more than 3 times. The incidence of cardiovascular events and total end-point events were significantly lower than those of the patients who achieved the goals more than 3 times. The difference was statistically significant (P0.05). The results of Log-rank test showed that all the patients died and the cumulative risk of cardiovascular events was lower than that of the patients who achieved the standard more than 3 times. The difference was statistically significant (P0.05). In the sixth year of management, the incidence of cardiovascular events was lower than that of the patients who achieved the standard more than 3 times, the difference was statistically significant (P0.05). Conclusion the combined fine management of community hospital and Grade 3A hospital can effectively improve the rate of T2DM patients meeting the standard, and the incidence of all-cause death and cardiovascular events in patients with total death and cardiovascular events decreased significantly in the sixth year of management.
【作者单位】： 北京市朝阳区劲松社区卫生服务中心;首都医科大学附属北京地坛医院病案统计室;北京军区总医院内分泌科;首都医科大学附属北京同仁医院内分泌科;
【基金】：首都卫生发展科研专项(2016-1-2057;2016-2-2054) 首都临床特色应用研究项目(Z151100004015021) 国际糖尿病联盟IDF-BRIDGES 4th Round of Funding(ST12-024)
【分类号】：R587.1
本文编号：2437379
[Abstract]:Objective to investigate the effects of 8-year management of type 2 diabetes mellitus (T2DM) on cardiovascular events and all-cause death. Methods A total of 441 T2DM patients from Jinsong community were selected as subjects in the (BCDS) study of Beijing community diabetes mellitus. The patients were followed up from August to December of 2008 and followed up to September 2016. There were no shedding cases. The patients were divided into two groups: intensive management group (n = 220) and standard management group (n = 221). The patients in both groups were managed by general practitioners under the guidance of experts in Grade 3A Hospital, followed up and monitored regularly, complications were detected as soon as possible and intervention was carried out. The difference in management between the two groups was mainly in the follow-up period and the frequency of detection of important indicators: the patients in the intensive management group were followed up every 2 months, and the Hb A1c was detected every 3 months. Urinary albumin excretion rate (UAER) was detected every 6 months. The patients in the standard management group were followed up every 3 months, Hb A1c was tested every 6 months, and UAER was detected once a year. The rate of reaching the standard and the rate of combined reaching the standard and the incidence of the end-point events were compared between the two groups from 2008 to 2016. The effects of the times of the combination reaching the standard on cardiovascular events and all-cause death were analyzed. Results in the intensive management group, the level of fasting blood glucose (FPG) in 2012 was lower than that in the standard management group. In 2015-2016, FPG,Hb A1c, low density lipoprotein cholesterol (LDL-C) and combined rate were higher than those in the standard management group. The blood pressure reached the standard rate in 2015 was higher than the standard management group, the difference was statistically significant (P0.05). All-cause deaths, cerebrovascular events, cardiovascular events, diabetic nephropathy, diabetic retinopathy, peripheral vascular events, tumor incidence and total endpoint events were compared between the two groups from 2008 to 2016. There was no significant difference (P0.05). 139 patients (31.5%) achieved the standard more than 3 times, the remaining 302 patients (68.5%) achieved the standard more than 3 times. The incidence of cardiovascular events and total end-point events were significantly lower than those of the patients who achieved the goals more than 3 times. The difference was statistically significant (P0.05). The results of Log-rank test showed that all the patients died and the cumulative risk of cardiovascular events was lower than that of the patients who achieved the standard more than 3 times. The difference was statistically significant (P0.05). In the sixth year of management, the incidence of cardiovascular events was lower than that of the patients who achieved the standard more than 3 times, the difference was statistically significant (P0.05). Conclusion the combined fine management of community hospital and Grade 3A hospital can effectively improve the rate of T2DM patients meeting the standard, and the incidence of all-cause death and cardiovascular events in patients with total death and cardiovascular events decreased significantly in the sixth year of management.
【作者单位】： 北京市朝阳区劲松社区卫生服务中心;首都医科大学附属北京地坛医院病案统计室;北京军区总医院内分泌科;首都医科大学附属北京同仁医院内分泌科;
【基金】：首都卫生发展科研专项(2016-1-2057;2016-2-2054) 首都临床特色应用研究项目(Z151100004015021) 国际糖尿病联盟IDF-BRIDGES 4th Round of Funding(ST12-024)
【分类号】：R587.1
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