| Background:In recent years,diabetes has become one of the four chronic diseases which is seriously harmful to human health,and is an epidemic trend all over the world.According to the International Diabetes Federation(IDF),about 463 million people worldwide suffered from diabetes in 2019.The prevalence of diabetes among Chinese adults is 11.2 percent,which means about 140 million people in China have diabetes.Therefore,the prevention and treatment of diabetes is extremely serious and urgent.Over the years,the studies have shown that diabetes can be effectively prevented and controlled through reasonable health management mode.Although chronic disease management mode has been discussed and accumulated some experience,there are also corresponding deficiencies.In this study,a new type integrated health management model based on the participation of general practitioners was adopted to carry out the intervention of community diabetes high-risk population.The purpose of this study was to explore the relationship between behavioral and biological factors and diabetes risk population,and to evaluate the effect of intervention.Methods:In this study,the community service center was taken as the unit,and 5,511residents with diabetes risk who met the inclusion criteria were selected as the target sample population according to the method of cluster sampling in the five districts of Shenyang.Data were collected through questionnaire survey,physical examination and biochemical index detection.The research group and control group were divided into two groups according to the region,which was a prospective cohort study.The research group was treated with the new type integrated health management model based on personalized and continuous services of general practitioners,while the control group was treated with traditional management model based on physical examination and consultation.The intervention period was 24 months.The two groups were followed up at 12 and 24 months,respectively.Data were collected through questionnaires(Depression and Anxiety Self-rating Scale,Social Support Scale,National Health Literacy Monitoring Questionnaire,SF-36 questionnaire,risk assessment questionnaire,etc.),and were collated and statistically analyzed according to IGPDP evaluation indicators.Basing on Spss24.0 and STATA14.0 software,T test and X~2 test were used to compare the intervention effect before or after the and between IGPDP and the traditional management mode.The effects of the two management modes front and back intervention were compared within the group.The mediating effect analysis was used to analyze the influencing factors and effects of fasting blood glucose.The structural equation model was used to analyze the path of diabetes.Results:A total of 5,511 people were surveyed,of which 43.3%were males and 56.7%were females.The age range of the population is 18-79,with 50-59 and 60-69 years old as the majority.From the aspects of social demographic factors,behavioral risk factors,biological factors,psychological state and other social health factors,this study conducted univariate and multivariate analysis on the influencing factors related to diabetes in the investigated population.The results showed that age,hypertension,quality of life SF-36 score,depression,total cholesterol and triglyceride were the main influencing factors for diabetes in the community sample.The following main results were obtained from the analysis of the influencing factors and mediating effects of fasting blood glucose in community population:(1)Triglyceride and anxiety had inhibitory mediating effects between smoking factors to fasting glucose values,while high-density lipoprotein and health literacy had synergistic mediating effects on fasting blood glucose.(2)Blood pressure,cholesterol,body mass index,anxiety and depression had synergistic mediating effect between drinking factors to fasting blood glucose,and health literacy had inhibitory mediating effect between drinking factors to fasting blood glucose.(3)Systolic blood pressure had an inhibitory effect between excess oil intake to fasting blood glucose,and low density lipoprotein had a synergistic effect between excess oil intake to fasting blood glucose.(4)Blood pressure,cholesterol,high-density lipoprotein,low density lipoprotein,health literacy,anxiety and depression had synergistic mediating effects between sedentary factors to fasting blood glucose.The research group and the control group were set up for the high-risk population of diabetes.In 24 months,the intervention group adopted the new type integrated health management mode,and the control group adopted the traditional management mode.Data were collected using clinical indicators and questionnaires during the 1-year and2-year follow-up periods respectively.Then,the effects of behavioral,biological,psychological and social health indicators before and after intervention were evaluated between groups and within groups.Results showed that two years later,under the intervention of the new type integrated management model,the rate of smoking,excess oil intake,sedentary were decreased,the level of blood pressure,blood glucose,BMI,cholesterol and triglyceride were significantly lowered,the anxiety and depression scores significantly decreased,the scores of life quality SF-36,health literacy and social support were increased significantly,the rate of the patient satisfaction and community doctors signing were significantly increased.The incidence rate of the new type integrated management model is lower than the traditional model.And its overall intervention effect on the community diabetes high-risk population was better than the traditional management model.Basing on previous studies and literature,each factor being classified as independent variable and the incidence of diabetes as dependent variable,a structural equation model was established to conduct a multi-factor path analysis of the incidence of diabetes in the target managed population after intervention.Results showed that the incidence of diabetes in the intervention group of the new type integrated health management model was mainly affected by gender and occupation.The new type integrated health management model had better effect on the control of diabetes incidence.If the intervention of occupational factors was added,it was expected to further reduce the risk of diabetes high-risk groups.Conclusions:1.The main influencing factors of diabetes in the community sample were age,hypertension,life quality SF-36 score,depression,total cholesterol and triglyceride.2.Fasting blood glucose of high-risk population under exposure to risk factors may be mediated by blood pressure,blood biochemical indicators,psychological status(anxiety,depression)and related social health(health literacy,social support).3.After 2 years intervention under the new type integrated model,the behavioral risk factors improved(the rate of smoking,excess oil intake,sedentary being decreased),smoking rates reduce excessive rate,cooking oil,reduce sedentary rate),the blood biochemical indicators improved(the level of blood pressure,blood glucose,BMI,cholesterol and triglyceride being significantly lowered),the psychological condition improved significantly(the anxiety and depression scores being significantly decreased),the related social health factors increased markedly(the scores of life quality SF-36,health literacy and social support being increased obviously),doctor-patient satisfaction and signing intention improved dramatically(the rate of the patient satisfaction and community doctors signing being markedly increased).4.According to the evaluation of the 2-year intervention effect of the two intervention models,the overall intervention effect of the new type integrated management model is better than that of the traditional one,which will provide reference for the health management of the community diabetes population in the next step. |
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