Study On The Effect Of Community Intervention Of Chinese Traditional Medicine With Non-drug Program On Patients With Type2Diabetes Mellitus

Objective:1.To investigate T2DM patients’situation, daily life behaviors and the type of the TCM syndrome in Xi Cheng District community in Beijing.2.To discuss the clinical effects of TCM with non-drug intervention on the T2DM patients,by comparison the changes between the front intervention and the later intervention,which include FBQP2hPQHbAlc,BMI,WHR,the score of syndromes,the scores of DSQL, the scores of anxiety and the situation of T2DM patients knowledge,attitudes and behaviors on diabetes mellitus and so on.3.To analysis the feasibility of the TCM non-drug program for the T2DM patients.Methods:1.The clinical cross-sectional study:The research used the cross-sectional study to the T2DM patients from five community health service centers (they include Dashala community,Guangnei community,Taoranting community,Shichahai community and Zhanlanlu community) in Xicheng District in Beijing,which from2013October to December.We used the Diabetes risk factors questionnaire (self-designed), the symptoms of diabetes scores questionnaire,the DSQL,the SAS,the Diabetes knowledge-practice-attitude questionnaire (self-designed) to survey T2DM,and measured the patient’s height, weight, waist circumference, hip circumference, and calculate the patient’s BMI, WHR, examined of patients with FBG, Ph2PG, HbAlc.We used the descriptive statistics and the binary Logistic regression to statistics and analysis the data by SPSS18.0.2.TCM non-drug program interventions in community:298cases were divided into control group and intervention group, the study period was16W.The control group with the conventional treatment (including regular exercise, diet and drug therapy),beside those treatment,the intervention group with emotional adjustment, dietetic therapy of TCM,exercise of TCM.Comparison of the enumeration data and measurement data between the intervention group and the control group at baseline before the intervention,to determine whether it can be comparable;Both of the control group and the intervention group patients were measured for the blood pressure, height, weight, waist circumference, hip circumference, and calculate the patient’s BMI, WHR, the symptoms of diabetes scores questionnaire,the DSQL,and examined of patients with FBG, Ph2PG,HbAlc at first and sixteenth W;Measured the intervention group of patient’s blood pressure, height, weight, waist circumference, hip circumference, and calculate the patient’s BMI, WHR, examined of patients with FBG, Ph2PG at eighth W;Surveyed on the situation of T2DM patients’ knowledge,attitudes and behaviors on diabetes mellitus for patients in the intervention group;Unless the data meet the normal distribution,it can be used the t test to analysis.But if not meet the normal distribution,the Wilcoxon test is used for statistics and analysis;Used χ2test to compare the sample rate between the different TCM non-drug programs.Result:1.Gender (OR=0.437), physical time (OR=0.458), leisure activities (OR=0.718) are protective factors for HbAlc,while the tension (OR=1.659), sweets (OR=1.680), drinking (OR=1.652) is a risk factor for HbAlc.2.There are25TCM symptoms in299cases in Xicheng District community, and the main symptoms are soreness and weakness of waist and knees in225cases (75.3%), fatigue in212patients (70.9%), dry mouth in194cases (64.9%),shortness of breatb186cases(62.2%);There are8type of syndromes,mainly for the Qi and yin deficiency syndrome in118cases (39.5%), deficiency of Yin Yang in76cases (25.4%), qi deficiency syndrome in35cases (11.7%), stagnation of liver and stomach heat syndrome in33cases(11%), yin deficiency and heat syndrome in30cases (10.0%);There are3accompanying symptoms,blood stasis in166cases (55.5%),phlegm in150cases (50.2%),wet in132cases (44.1%).3.After16W,the control group had statistical significances in systolic blood pressure (P=0.016), FBG (P=0.005), P2hPG (P=0.035), P<0.05,others no statistically significant;4.After8W and16W,the intervention group had statistical significances in systolic blood pressure (P=0.041), FBG (P=0.047), P2hPG (P=0.000), HbAlc(P=0.000), symptom score (P=0.013), DSQL (P=0.000), P<0.05, HbAlc (P=0.042), symptom score (P=0.000), DSQL (P=0.000), P<0.05,with statistical significance,others no statistically significant.5.In145patients with T2DM SAS scores are25～73.75points, the average score is45.79±9.23(95%CI:44.28-47.31).The scores of normal in98cases, and the scores≤50points in47cases, the rate of anxiety state is32.4%.Did the second SAS survey for the intervention group.Saw the difference between front and later by using the Wilcoxon test, P=0.000, P<0.01, with statistical significance.6.1n148patients with T2DM the diabetes knowledge questionary scores are0-10points, the average score is6.89±2.43points, score≥6points with110people (74.32%).Among the147cases of patients in the intervention group after16W, did the second diabetes knowledge survey, scored2-10points,average8.93±1.49points. Used the the Wilcoxon test to compare, P=0.000, P<0.01,with statistical significance.7.Three items for the patients with clinical effects are better than that single or double for patients,contrast the three items and the non three items,used j^test,the result were χ2(4.397),P=0.036,P<0.05,with statistical significance.While between the single or double,χ2(0.458), P=0.795(df=2), P>0.05,χ2(0.298), P=0.861(df=2), P>0.05, with no statistical significance.The TCM non-drug program has certain feasibility and acceptability:There were103(71.03%) of T2DM patients thought that they had effects after accepted TCM non-drug program;There were126cases (86.9%) of T2DM patients thought that they could insist the TCM non-drug required.Conclusion:1.The community as the basic medical service institutions, can play an important role in the prevention and treatment of diabetes, hypertension and other chronic-diseases.2.Gender, physical time, leisure activities are protective factors for HbAlc, while tense, sweets, alcohol-drinking are risk factors for HbAlc.Therefore, the doctors should encourage the T2DM patients to increase the physical activity time and participate in extracurricular activities in a appropriate way.Meanwhile the communities face for the patients,so they always are advocated to provide patients with more contents, more abundant leisure activities, to improve their quality of life.3.Qi and Yin deficiency Syndrome is the most common type of T2DM patients, as the disease evolution,the blood stasis syndrome is the commonest accompanying syndrome.Due to the living habits, natural environment, social and environmental have changed,the phlegm, dampness syndrome should not be ignored.In the prevention and treatment of diabetes and its complications, should be based on supplementing Qi and nourishing Yin, activating blood circulation and according to the disease should pay attention to clinical application of blood stasis and phlegm dampness method.4.Anxiety state exists in T2DM patients ubiquitous, the TCM non-drug program can alleviate the symptoms of anxiety, effective control of blood glucose.5.TCM non-drug program not only can effectively control and stable blood pressure, FBQ Ph2PG, HbAlc for the T2DM, but also can significantly improve the patient’s symptoms and improve quality of life of patients.6.Xicheng District community T2DM patients had good attitude and high awareness on diabetes, and TCM non-drug program can be acceptable and feasible to the T2DM patients.