| PrefaceDiabetes Mellitus is a common disease,and has become an important social health issue which threatened health status of people in China due to long duration of disease, excessive complications,complicated state of diabetes control and the large use of health resources.The treatment and caregiver burden of Type 2 diabetes and its complications in elders is increasing along with the fast aging problem in China. Developing health management of elders with Type 2 diabetes in community and establishing effective management mechanism for long time are effective measures to prevent and control diabetes.As a part of China/UK Urban Health and Poverty Project, this research aimed to explore the model of health management in elders with type 2 diabetes by making use of the theories and techniques of health management,and figure out the resolution of problems such as the lower social security conditions in elders of Shenyang,large number of people with diabetes,and lower level of diagnosis and treatment in community.Subjects and MethodsA population-based cross-sectional survey was designed to investigate chronic diseases of 2656 community-dwelling residents who were more than 65 years old in nine communities of Weigong Street,Tiexi District,from whom 267 type 2 diabetic patients were screened out.Participants for the study were selected by volunteering from those diabetic patients who lives in the three communities near the health service center.There are 75 diabetic patients and their age rang from 65 to 79 years.Demographic characteristics,self-care behavior,diabetes control,medication and diabetic knowledge was assessed using "Health File of Elders with Diabetes" and "Diabetic Self-care Questionnaire"(designed by study team).Medical Coping Modes Questionnaire was used for measuring coping style of patients,and weight,blood pressure,blood glucose and hemoglobin of glycosylation were measured at the same time.Firstly,health improvement measures were made by experts for each patient on the basis of health risk appraisal.Secondly,we trained the general physicians in the community who participated in the program about the theory and practice of health management.Finally,general physicians in the community did the diabetic health management under the direction of experts.The details of management consisted of health education,quantifycational dietary,quantificational exercises,reasonable medicine and self-monitoring.The study began in May 2006 and ended in April 2007.ResultsThe 70 individuals who were effective to the study consisted of 28 men(40.0%) and 42 women(60.0%)with type 2 diabetes,who were an average age of(70.50±4.10) years.The average of duration of diabetes was(6.58±6.24)years,and 51.4%of the participants had already developed complications of diabetes.After community intervention,patients were more improved with their diabetic knowledge(p＜0.05).The proportion of dietary control decreased after a little increase,but not statistically significant;the proportion of exercise also decreased after a little increase,and decreased significantly at the end of the intervention compared with 6 months(p＜0.05); the proportion of regular medication increased significantly at 3 and 6 months compared with baseline(p＜0.05),and decreased at the end of the intervention but not statistically significant;a significant improvement was found in the proportion of regular monitoring after intervention compared with baseline(p＜0.05).The levels of fasting blood sugar and blood sugar 2 hours after meals were both decreased significantly(p＜0.05).There was significant improvements in both mean and standardized rate of hemoglobin of glycosylation(p＜0.05).Blood pressure and body mass index decreased significantly after intervention(p＜0.05).Most of the patients with diabetes adopted "avoidance" and "resignation" coping mode compared with the norm.Results of multiple regression analysis indicated that dietary control and coping style have significant effects on diabetic control(p＜0.05).ConclusionsCombined technique resources of higher medical college with health resources of community,offering individualized treatment plan had significantly effect for diabetes control of community elders with type 2 diabetes.
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