| Diabetes mellitus (Diabetes mellitus, DM) is a group of high blood glucose metabolic disease characterized by. In our country, with the accelerated change people’s way of life and the process of aging, the prevalence of DM increased rapidly. One can represent the above 20 years old adult DM prevalence survey completed in 2008, China’s DM prevalence rate has reached 9.7%, has become the world’s first big DM. DM and its complications brought heavy economic burden to patients and society. DM’s goal of treatment is to control blood sugar effectively, avoid or delay the occurrence of complications, improve the quality of life of patients. While the treatment of DM in China has many problems:lack of knowledge, lack of proper nutrition, lack of scientific movement, lack of proper monitoring, the lack of professional guidance. With China’s aging process significantly, community standardized management of diabetes is very important.This article through to the Shanghai City Tianlin street community diabetic patients with follow-up management, evaluation of the community DM patients and patients with impaired glucose tolerance status of blood glucose control and self management behavior, and evaluate the effect of community health management, and to provide a basis for improving the community diabetes management.Using systematic sampling method, follow-up, monitoring of blood glucose, blood glucose level, analysis of factors affecting the satisfaction evaluation of glycemic control in patients with diabetes and impaired glucose tolerance in Shanghai City Tianlin community in the management of patients, and health education, intervention. These data collection and multivariate Logistic regression analysis, analysis and evaluation of the community for glycemic control in patients with diabetes and related factors.Results1. Current management of patients with type 2 diabetes community managementImpaired patients were mainly elderly diabetes patients and sugar Tianlin community management of resistance,471 respondents (the main study object from health records and community clinics, respectively,32.1% and 63.3%), male 43.7%, female 56.3%; mean age 68.33±9.84 years old subjects, aged 60 years and above 80.3% of the total. Patients with a median of 5 years; primarily in type 2 diabetes, accounted for 92.5%. Have a family history of diabetes in the survey accounted for 29.9%, without family history accounted for 58.4%; to carry out physical examination in 471 cases of the survey coverage, the average height is 163.28±8.18cm, the average waist size of 87.07±9.58cm,96.52±8.41cm average hip. The fasting glucose test in 471 patients, the cards, fasting blood glucose (FPG) was 6.68± 1.46mmol/L, minimum 4.4mmol/L,17.5mmol/L maximum; fasting blood glucose control ideal proportion 45.2%, control rate was 44.2%, compared to 10.6% control is poor.2. Follow up with the amount of damage in patients with diabetes resistant and community managementAccording to the requirements of "Shanghai diabetes prevention guide". Tian Lin community for patients with type 2 diabetes to carry out standardization management, carry out patient follow-up and health education quarterly.The first follow-up survey, the average weight of 471 subjects was 65.36± 11.01kg; systolic blood pressure mean was 128.26±11.46mmHg, diastolic blood pressure mean was 76.13±8.16mmHg. Body mass index (BMI) control ideal proportion is 53.1%; blood pressure control is the ideal ratio of only 28.9%, poor control of the ratio of 16.1%. There are 40 patients belonged to the early management group, accounted for 8.5%; 372 cases belonging to the excellent, accounted for 79%; 59 cases belong to the poor, accounted for 12.5%. Fasting blood glucose (FPG) was 6.66±1.44mmol/L; fasting blood glucose control ideal proportion 45.2%, control rate was 12.3%. Random blood glucose testing was 101 cases, accounting for 21.44%, the mean was 8.64±1.97mmol/L; random blood glucose control ideal proportion 46.5%, control rate was 38.6%, compared to 14.7% control is poor.The majority of patients without clinical symptoms, accounted for 85.4%; has the symptom with polydipsia and polyuria,33 patients. The majority of patients without fundus examination,393 cases,83.4% cases; do as normal,67 cases.Most of the patients with oral antidiabetic drugs,68.6% unmedicated patients accounted for 29.9%. The use of a sulfonylurea,190 cases with insulin treatment only in 40 cases.The vast majority of patients with diabetes mellitus and impaired glucose tolerance patients during the follow-up management of non drug therapy,469 cases. Mainly by salt in 460 cases, dietary fat reduction in 444 cases,301 cases with regular exercise, relax mood in 310 cases; among the 455 patients with at least two measures. Intensity of physical activity in leisure time, most of the mild activities,364 cases, accounting for 77.3%; 66 cases of moderate activity; 41 cases were not too activities. The majority of patients with time is 0.5-1 hours,346 cases, accounting for 73.5%; 68 cases within 49 hour 1-2 hours. Most of the patients have no mental health,439 cases,93.2%; there are many insomnia,15 cases. Most of the patients have more time by the doctor or diet material performance requirements, in 443 cases, accounting for 94.1%.The first follow-up of patients with blood glucose control level was 187 cases, accounting for 39.7%; the general was 218 cases, accounting for 46.3%; 66 cases were poor, accounting for 14%.358 cases were mainly the door follow-up (76%),110 cases of outpatient follow-up (23.4%). The use of insulin therapy was 8.5%, but with the extension of course, gradually increase the proportion of patients treated with insulin (X2=49.168, P<0.05).49.5% of the patients received follow-up management standard,91.2% of the patients in the follow-up and received health education.3. Damage factors affecting blood glucose control in patients with type 2 diabetes in community management and impaired glucose tolerance3.1 The control of blood glucoseBlood glucose for glycemic control of diabetic patients evaluation criteria, using K-W test method, analysis of its associated with gender, age. The results showed that there was no significant difference in blood glucose control level associated with gender and age, and there was significant difference (X2=13.248, P<0.05).There are statistically significant by K-W test method for the analysis of the course and the level of blood sugar control two (X2=11.153, P<0.05). Analysis of the relationship between the patients with BMI X2=3.273, P>0.05.3.2 alysis of the use of blood glucose control and drugUsing K-W test, analysis of the relationship between the level of blood glucose control in patients with drug use visible, whether the use of drugs to control blood sugar levels correlated with patient (X2=24.293, P<0.05), categories and levels of blood glucose of patients with drug use independent (X2=1.003, P>0.05).3.3 Blood glucose control and according to doctors for diet analysis:no statistical significance, may be the disease severity is different, leading to the implementation of the requirements of different doctors.ConclusionTianlin community management in patients with type 2 diabetes in the elderly, more women than men; a longer course of disease, course of disease in the majority of patients without clinical symptoms; most patients with oral hypoglycemic drug treatment, insulin treatment is relatively low; the course was less than 5 years of fasting blood glucose reached the highest standard rate; blood pressure control rate is low; the majority of patients both diet control and regular exercise, patient compliance and community management standard is better; the main influencing factors of blood glucose control in patients with:normative duration, body mass index, waist hip ratio and community follow-up. |
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