| Research purposesBy understanding the situation of standardized management of patients with type 2 diabetes in the community,to evaluate the level of blood glucose control and quality of life in patients with type 2 diabetes,and analyze the influencing factors,to provide a scientific theoretical basis for standardized management of patients with type 2 diabetes in the community.Research methods1.Relying on the Shandong Provincial Residents’ Health Records Service Project,Taiyang District Taishan District Community Health Service Center was selected as the research site.The health records of the residents of the community from March 2012 to June 2012 were selected as the baseline data,according to the diagnostic criteria for diabetes and included Excluding conditions,select study subjects,establish a study cohort for patients with type 2 diabetes;further collect follow-up data,and divide the subjects into control compliance groups and non-compliance groups in accordance with the criteria for fasting blood glucose control,using the 《Guideline for Type 2 Diabetes Prevention in China(2017 Edition)》 glycemic control goal,assessing the community’s standardized management of fasting blood glucose control in type 2 diabetes,using multiple linear regression analysis,logistic regression analysis,and orderly logistic regression analysis for multivariate analysis to find fasting blood glucose control in community type 2 diabetic patients The level of risk factors.2.A cross-sectional survey was conducted to investigate the type 2 diabetes patients managed by the chronic disease department of the community health service center.The Diabetes Quality of Life Specific Scale(DSQL)was used to measure the patient’s quality of life.The Pearson correlation analysis and the AMOS software were used to fit the structural equation model of the quality of life scores,and the path coefficients among the variables in the model and the main relevant factors affecting these scores were explored.Results1.The basic characteristics of the cohort:A total of 647 people were in this cohort,including 228 males,with an average age of 67.22±7.92 years old and 419 females,with an average age of 68.28±7.22 years;529 patients with a family history of diabetes mellitus(81.77%);educational level of primary and secondary school and below 40.80%,marital status is mainly married,accounting for 79.29%;medical expenses are paid by urban medical insurance with 58.27%.The lifestyle characteristics of the cohort population showed that there were 427 people(66.00%)with relatively balanced dietary intake,132(8.8%)with wedding candy,48(7.42%)with daily alcohol intake,and 342(each day)with exercise.52.86%.The average BMI of the cohort was 25.94±3.38kg/m2,of which 266 were overweight patients,accounting for 41.11%;177 patients were complicated with hypertension,accounting for 27.36%;136 patients with coronary heart disease accounted for 21.02%,with dyslipidemia 247 patients,accounting for 38.18%.2.Influencing factors of fasting blood glucose level after standardized management of the cohortThe average fasting blood glucose level of the cohort after standardized management of community health service centers was 7.00±2.65 mmol/L.Single-factor,multiple linear regression analysis results showed that the medical cost payment method is a new type of rural cooperative medical care,a low level of education,divorce of the widowed,drinking more,family history,the greater the BMI,the longer the duration of diabetes,the beginning of the use of drug treatment patients standardized The higher the level of fasting blood glucose control after management(all P<0.05).Structural equation model analysis further showed that demographic characteristics(effect 0.824),pre-existing disease conditions(effect 0.415),and medication status(effect 0.291)had a positive effect on the level of fasting blood glucose after standardized management;0.291).Lifestyle(effect-0.780)and BMI grade(effect-0.038)had a negative effect on fasting blood glucose levels after standardized management.3.Influencing Factors of Fasting Blood Glucose Control after Standardized Management of Queue PopulationAfter standardized management,the cohort was grouped according to fasting glucose(fasting blood glucose <7.0mmol/L)and poor fasting blood glucose control(fasting blood glucose≥7.0mmol/L).There were 351 cases with good fasting blood glucose control,accounting for 54.25%.Its average blood glucose level was 5.34±1.62 mmol/L.Poor control of fasting blood glucose in 296 cases,accounting for 45.75%,and the average blood glucose level was 8.87±2.80 mmol/L.Univariate and logistic regression analysis showed that the risk factors affecting the control of fasting blood glucose control were: unmarried(OR=2.454,95%CI:1.367-4.404),urban residents’ insurance(OR=2.005,95%CI:1.266-3.173),Overweight(OR=3.743,95%CI: 2.101-6.668),Obesity(OR=2.511,95%CI:1.383-4.560),Oral hypoglycemic agent(OR=2.994,95%CI: 1.134-7.903).4.Influencing factors of difference in fasting blood glucose levels before and after standardized management of the cohortUnivariate and multiple linear regression analysis showed that: The higher the level of education,reduce the use of drugs,BMI value is reduced,marital status is better,the diet becomes more balanced,exercise increased,the recovery of coronary heart disease,reduced blood lipids patients before and after the standardized management of fasting blood glucose difference The greater the value change.The longer the duration of diabetes patients,the smaller the difference in fasting blood glucose before and after standardized management.5.Factors influencing the control effect of fasting blood glucose levels before and after standardized management of the cohortIn order to explore whether the community health service center’s standardized management measures for 647 patients with type 2 diabetes in the cohort were effective,those who met fasting blood glucose and did not meet the standard but had decreased fasting blood glucose did not meet the criteria and fasting blood glucose did not decline or even increased.The patients were divided into three groups as the criteria for compliance,effectiveness,and invalidity,and the factors influencing the effectiveness of standardized management measures were analyzed.The results of single-factor,ordinal Logistic regression analysis showed that the age was higher and the management effect was lower,OR=1.664,P=0.003.The education level grouping has statistical significance.The higher the degree of education is,the better the management effect is,OR=0.65,P=0.002.Urban employee insurance had a better management effect than urban residents’ insurance and new rural cooperative medical care,with OR=3.124,P<0.001.Family history was a risk factor that affected management effectiveness,OR=2.151,P=0.001.The more exercise,the better the management effect,OR=0.431,P=0.001.The course of the disease was a risk factor that affected the management effect.OR=1.540,P<0.001.The risk factors of coronary heart disease affecting management were OR=0.376,P=0.010.The grouping of drug use was statistically significant,indicating that the initiation of drug therapy was a risk factor that affected management effectiveness,OR=5.585,P<0.001.The increase of BMI value reduced the management effect,OR=1.927,P=0.023.6.Factors affecting the quality of life of type 2 diabetesThe scores of physiological functions,psychological dimensions,social relationship dimensions,treatment maintenance,and total scores of diabetic patients were 35.36±5.07,25.38±4.50,12.85±2.94,10.02±2.59,and 83.62±9.54,respectively.Univariate and multiple linear regression analysis showed that the higher the BMI value,the more alcohol consumption,the worse the physiological function of patients who started to use drug therapy,the new rural cooperative medical care,and family history,and the better the physiological function of patients with higher education level.The new rural cooperative medical care and the use of drug therapy,the worse the psychological status of patients with greater BMI values,and the better the psychological status of patients with higher educational levels.The greater the BMI,the new rural cooperative medical care,the more medications used,and the more patients with smoking,the worse the social relationship status.The higher the education level,the better the social relationship status of the patients.The greater the BMI value,the new rural cooperative medical care,the longer the disease course,and the greater the impact of treatment on the quality of life of patients starting to use drug therapy.The higher the BMI,the new rural cooperative medical care,the beginning of the use of drug therapy,the worse the quality of life of patients with widowed/divorced,and family history,the better the quality of life of patients with higher education levels.The structural equation model analysis further showed that lifestyle characteristics(effect 0.419)had a positive effect on the quality of life of diabetic patients;management of thick fasting blood glucose levels(effect-0.853)had an impact on the quality of life of diabetic patients and showed a negative effect.Conclusion1.Factors affecting the level of fasting blood glucose control in patients with type 2 diabetes in the community are: payment methods,education level,marital status,family history,BMI grade,duration of diabetes,use of drugs,and coronary heart disease.2.The influencing factors of quality of life of patients with type 2 diabetes in the community are: BMI grade,payment methods for medical expenses,drug use status,education level,marital status,and family history. |
PDF Full Text Request