| BackgroundIn the past 20 years, the morbidity rate of diabetes in China increased rapidly. In 2010, there are more than 92 million diabetic patients in China. China becomes a country with the largest number of diabetic patients in the world. Diabetes has characteristics such as long duration, many complications, and high rate of disability, which will bring great burden to individuals, families and the government. Diabetes becomes an urgent public health problem. Therefore, how to control and manage diabetes effectively is an urgent issue to be resolved.China's community health service develops rapidly in the last 20 years. Many community health service organizations have begun to manage diabetes, though, the content, style and procedures of diabetes management are different from each other. There is lacking of a uniform standard of diabetes management model for community. Health departments in many regions of China explored the community management of diabetes, and created many different models of diabetes management. Generally speaking, there is lacking of an effective management model, and the present diabetes management in community is far from perfect.Many domestic and international experiences have showed that manage diabetes in community is the most effective approach. Although diabetes management in community in China is still at the initial stage, community health services as the integrated control platform is an inevitable trend. Thus, it is essential to develop the standardized management model of diabetes in community.ObjectiveInvestigate a community in Hangzhou city of Zhejiang province which carries out the standardized management in patients with diabetes, summarize its management model, and analyze its effect in this community and in other community which applied its model. Study in the standardization management of diabetes community, and discuss the model in community. Provide references for the management of chronic diseases in communities in China.Methods1. Literature reviewDomestic and foreign literatures which related to the topic of standardized management of community-related chronic disease research (especially diabetes) were reviewed comprehensively. Studies, experiences, and effects of chronic disease (especially diabetes management) management at home and abroad were investigated. Research status, policies, and the current implementation of diabetes management in community in China were surveyed.2. Sampling approach(1) Purposive samplingA community in Hangzhou, which carries out the standardized management in patients with diabetes, was chosen as the study group. Another similar community, which patients with diabetes were managed without carrying out the standardized, was chosen as the matched group.(2) Cluster samplingThe general information and follow-up information of diabetic patients in two groups in past 5 years were investigated and analyzed.(3) Random sampling Four communties extracted from thirty communities was chosen as the study group. These thirty communities which carried out standardization management of diabetes in 2009-2010, were the base communities of chronic disease management in Zhejiang province.3. InterviewsInvestigate the specific measures and empirical methods in community management of diabetes through interviewing with the staff in the community health services.4. InvestigationPatients'general information and follow-up data before and after application of standardized management models are investigated.Results1. Diabetes standardized management in community(1) Standardized management model of diabetes in community includes: utilization of the community health resources, formation of the general team and the division of labor, diabetes management process standardization, and health records management grid, the implementation of a comprehensive and effective health education Reasonable indicators of several aspects of the assessment(2) In the end, there are 222 persons in study group and 232 persons in control group. No significant difference (P> 0.05) was found between the study group and control group of people in the sex, age, occupation, native place, education and other aspects of demographic characteristics.(3) At baseline (the first quarter of 2005), the follow-up rate was 97.83% in the study group, while that of the control group was 78.05%. There was no significant difference between them (x2=0.513, P=0.474). Two years later (the fourth quarter of 2006), the follow-up rate were 96.83% and 66.67% for the study group and the control group, respectively, exhibiting a significant difference (χ2=4.198, P=0.040); To the end of the study (ie, the second quarter of 2009), the follow-up rate were 90.99% and 44.40% for the study group and the control group, respectively, resulting a very significant difference between the two groups (x=22.224, P<0.01).(4) At baseline (the first quarter of 2005), the rate of ideal blood glucose control (RI) were 19.57% and 12.20% in the study group and the control group, respectively. No significant difference between the two groups was found (χ2=0.633, P=0.426). In the second quarter of 2007, the RI were 27.27% and 13.67% for the study group and the control group, exhibiting a significant difference (χ2=4.566, P=0.033). In the third quarter of 2008, a very significant difference was found between them (P<0.01). In the first quarter of 2005, the compliance rate of blood glucose control (RC) were 50% and 31.71% for the study group and the control group, respectively. No significant difference was found between the two groups (χ2=1.255, P=0.263). In the first quarter of 2007, the Rc were 47.13% and 24.30% for the study group and the control group, exhibiting a significant difference between the two groups (χ2=5.326, P=0.021). In the third quarter of 2008, a very significant difference was found between the two groups (P<0.01).(5) In the first quarter of 2005, the average fasting blood glucose were 8.211±3.2743 mmol/L and 8.066±1.6673 mmol/L for the study group and the control group, respectively. No significant difference was found between the two groups (P> 0.05). In the second quarter of 2009, the average fasting plasma glucose value were 7.061±1.6873 mmol/L and 7.343±1.5118 mmol/L for the study group and the control group respectively, resulting a significantly different between the two groups (P<0.05).(6) To the end of the second quarter of 2009,153 patients were found have complications or complications in the study group, while in the control group there were 191 patients have complications or complications. A very significant difference was found between the two groups (P<0.01). 2. The effect of diabetes standardized management model in the other communties of Zhejiang province(1) The construction of GP's teamThe model is helpful for the community which has been established the GP's team or not. Two of them have built a new GP's team, which is consist of GPs, public health managers, nurses and other Professional Staffs.(2)The effect of diabetes managentmentThe model is good for some aspects in community health service, such as discover and management of diabetes, the awareness of residents on the knowledge of chronic disease, the residents'satisfaction on community health service, and so on. There is no evident change on the manage rate and control rate of diabetes.Conclusions1. A standardized management model of diabetes in community should include following aspects:community resource utilization, general practitioners'team, workflow, information management, patient's education, and assessment indicators.2. The standardized management of diabetes in the community plays an important role in maintaining the continued follow-up, controlling blood glucose, decreasing the incidence of complication in patients with diabetes. It is an effective way to manage patients with diabetes in community.3. The Standardized model applied one year later, some aspects were improved, such as General Practitioners'team building, the patients'number of discover and manage, the residents'knowledge of chronic disease, and the residents'satisfaction on community health service.
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