Application Of Hospital-Community Integration Self-Management Team Study On The Effect Of Health Management For Diabetic Patients

Obiective:To evaluate the effect of hospital-community integrated diabetes self-management team and explore the potential value of physical fitness and muscle fat ratio in evaluating intervention measures.Methods:A diabetes self-management group was set up in the metallurgical community health service center of Urumqi City,Xinjiang.200 patients with type 2 diabetes mellitus（T2DM）aged 50-70 with good compliance were randomly selected and randomly divided into 10groups.The measures of hospital-community integrated diabetes management model were used.10 groups were intervened to improve self-management ability for one year.Through the questionnaire survey of diabetes related knowledge,the information of diabetes related knowledge awareness rate was collected.The relevant indicators before and after patient management in self-management group were collected through physical biochemical examination,physical fitness test and human body composition test.During the management period,patients were followed up once every three months,and health education was carried out pertinently.At the same time,patients’blood sugar control,medication and transportation were understood.Exercise and diet.Through statistical analysis,the effect of diabetes self-management group was evaluated in the following five aspects:1.blood sugar control（FPG,Hb A1c）.2.related metabolic indicators control（TC,TG,HDL-c,LDL-c,SBP,DBP）.3.analysis of patients’macrovascular function（cardiac function indicators,CRP）.4.analysis of patients’motor function.（Physical fitness,muscle fat ratio）.5.Diabetes related knowledge awareness rate.At the same time,the correlation between physical fitness,muscle fat ratio and blood sugar level was analyzed.Results:1.Basic information:There were 200 patinets in the self-management group,aged（60±6）years.Among them,88 were males and 112 were females.120（60.0%）had a family history of chronic diseases,46（23.0%）had a family history of diabetes mellitus.2.Evaluation of the effectiveness of the self-management team of T2DM:1)Blood sugar control:FPG（7.72±2.14）and Hb A1c（6.90±0.88）in self-management group were lower than those in pre-management group（8.92±2.73）and Hb A1c（6.90±0.88）,with significant difference（P<0.05）;2)Analysis of related metabolic indicators of patients:total cholesterol（4.95±1.07）,triglyceride（1.78±0.89）,low density lipoprotein（2.57±0.86）,systolic blood pressure（130.89±11.26）,diastolic blood pressure（85.39±10.85）,central artery pressure（118.47±16.08）were lower than those before management in self-administered group.with significant difference（P<0.05）;There was no significant difference in HDL-c between before and after management（P>0.05）;3)Macrovascular function analysis:Thecentral artery pressure difference（39.16±12.68）,pressure increment（9.83±5.72）,AIx（21.92±9.20）,C-reactive protein（2.94±0.71）after the management of diabetes self-management group were lower than those before the management,the difference was statistically significant（P<0.05）;there was no statistical difference in the time of blood pump（P>0.05）.Multivariate logistic regression analysis showed that waistline were risk factors,OR（95%CI）were 1.057（1.01～1.11）;4)Analysis of motor function of patients:After self-management group of diabetes with body weight（66.95±10.51）,BMI（24.67±3.08）,waist-hip ratio（0.92±0.06）,body fat（21.27±6.20）,body fat percentage（28.81±6.00）,skeletal muscle（27.30±6.17）,basal metabolic rate（1589.96±494.02）,vital capacity（2665.40±732.62）and selective reaction time（0.55±0.10）were higher than those before management,and the difference was statistically significant（P<0.05）;5)The awareness rate of diabetes-related knowledge:There were significant differences between the patients before management and the patients before management in the following aspects:（1）Common symptoms of diabetes mellitus（2）Diabetes-prone diseases（3）Can diabetes be cured?（4）Knowledge of the best indicator for the diagnosis of diabetes（P<0.05）.3.The correlation between fitness,muscle fat ratio and blood sugar and linear regression:1)The correlation between the proportion of muscle fat and the control rate of blood sugar in the self-management group showed that there was a positive correlation between body weight and obesity and Hb A1c（P<0.01）,and the correlation coefficients r were 0.778 and 0.430,respectively;the basal metabolic rate was negatively correlated with Hb A1c（P<0.01）,and the correlation coefficient r was-0.234;the body weight was positively correlated with FPG.（P<0.01）,correlation coefficient r was 0.246;2)The correlation between physical fitness and blood sugar control rate in self-management group showed that vital capacity and standing time on one foot were negatively correlated with Hb A1c（P<0.01）,and the correlation coefficients r were-0.269 and-0.204,respectively;3)（1）The linear regression model established by patient independent variable"weight（X₁）"and dependent variable"FPG（Y）"after management has significant statistical significance（P<0.05）.The model expression of weight and FPG is Y=4.897+0.066X₁.（2）The linear regression model established by patient independent variable"weight（X₁）"and dependent variable"Hb A1c（Y）"after management has significant statistical significance（P<0.05）.The model expression of weight and Hb A1c is Y=2.543+0.054 X₁.Conclusion:1.Under the guidance of hospital endocrinology department and the direct intervention of community staff,self-health management of patients in self-management group has obvious effect.Through a series of strengthening effective management,blood sugar and blood pressure of most patients are lower than before,and the risk of cardiovascular disease is reduced.Most patients have gradually developed good habits such as adjusting diet structure and persisting in exercise,and the self-management group of diabetes has established the belief that patients are responsible for their own health and that diabetes can be prevented and cured,so as to improve the compliance of patients with follow-up management.Let patients realize the importance of self-management,it is worth promoting and promoting.2.Through the correlation and regression analysis of physical fitness,muscle fat ratio and blood sugar,it was found that controlling the weight of diabetic patients,adjusting diet reasonably and strengthening physical exercise can not only increase the cardiopulmonary function of patients,but also improve the blood sugar level of patients and delay the occurrence of diabetic complications,which is of great significance to improve the quality of life of patients with T2DM.