Comparison Of The Implementation Effects Of Different Management Models For Diabetes Patients In Urban Communities

Objectives:Describing three kinds of Diabetes management model in urban community health service centers. Comparing the effects that different management pattern to control the diabetics’conditions and exploring a more effective management mode of urban community diabetics.Methods:The samples and part of laboratory testing data of this research come from Beijing Community Diabetes Research of the "The joint management model of diabetes in 3-A-grade hospitals and multicenter communities and its improvement in actual control effect" and a total of 213 patients with type 2 diabetes were included in the study. According to the simply randomized design, these patients were divided into two groups. Patients in the first group received the strengthened medical management and those in the second group received standard medical management. Based on their willing, some patients in the first group were invited to join the diabetes self-management team and accept the comprehensive management. So the final result of grouping was standard group, strengthen group and comprehensive group. The number of patients in three groups are 106,75,32, respectively. The content of this research mainly includes the physical examinations, biochemical tests, relevant knowledge and behavior questionnaire of the diabetics and calculation of the time cost. Data collection included demographic characteristics of the object of study, related physiological and biochemical indexes in different diabetic stages (body mass index, waist circumference, fasting glucose, glycosylated hemoglobin, systolic pressure, diastolic pressure, triglyceride, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), differences of patients’ related knowledge and behavior about diabetes from beginning to end of management, different time cost in different management methods.t test, analysis of variance, Chi-square test etc. were used to statistically analyze the data and evaluate the effectiveness of different management methods.Results:According to the results from three groups in 18 consecutive months:Fasting Blood Glucose, Glycosylated Hemoglobin and Cholesterol showed a downward trend in all the three groups, in which the downtrend in comprehensive group is more obvious than that in strengthen group and standard group had a minimum of downtrend.After 18 months’management, change of Fasting Blood Glucose, Glycosylated Hemoglobin, Triglycerides and Cholesterol etc. show statistically difference among the three groups. The decline of Fasting Blood Glucose in comprehensive group is more apparent than those in standard group and strengthen group. Glycosylated Hemoglobin, Triglycerides and Cholesterol in comprehensive group and strengthen group showed a more obvious decline than that in standard group. Control rates of Fasting Blood Glucose in standard group, strengthen group and comprehensive group was 62.86%,77.03%,81.25%, respectively. Control rates of Glycosylated Hemoglobin in three groups were 59.05%,71.62%,81.25%, respectively. These results showed statistically significant differences by Chi-square test.After the treatment by different management modes, patients in three groups increased knowledge of diabetes and the improving rate has statistically significant difference. The improving rate from the patients in comprehensive group is higher than that from the patients in strengthen group. Meanwhile patients from standard group improved least. The differences of Blood glucose monitoring frequency, regular foot inspection rate, medication compliance rate among three groups showed statistically significant.The average consultation time was 3-8.35 minutes for every Type 2 diabetics in general outpatient clinics and the time in specialist clinic was 16.5 minutes. In diabetes self-management group, the average time that every medical staff provided counseling for each member was 9.09 minutes.Conclusions:Comprehensive management for diabetics is more beneficial to control the conditions of the diabetics, improving the target rate of Fasting Blood Glucose and Glycosylated Hemoglobin and increasing patients’mastery of diabetes-related knowledge and skills. As for the large-scale promotion of Comprehensive Management Mode, it would still need further accounting in economic and time costs.