深圳大鹏新区社区糖尿病医疗护理现状研究
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(1. 深圳市大鹏新区葵涌人民医院三溪高源社区健康服务中心,广东 深圳 518000;2. 深圳市第二人民医院 深圳大学第一附属医院,广东 深圳 518035;3. 深圳市大鹏新区葵涌人民医院葵丰社区健康服务中心,广东 深圳 518000)

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石金霞,女,主治医师,主要从事社区全科诊疗,慢性病管理工作。

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R 587.1;R 473.5

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Study on the Current Situation of Community Diabetes Medical Care in Dapeng New District of Shenzhen
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    摘要:

    〔摘 要〕 目的:通过对深圳大鹏新区大型社区健康服务中心(下称 “ 大鹏社区 ”)就诊的成人糖尿病患者进行调查, 了解大鹏社区糖尿病患者的医疗护理现状,为深圳大鹏新区政府及医疗集团慢病管理决策提供数据支持。方法:纳入 2019 年 4 月至 2021 年 4 月期间 7 家大鹏社区日常就诊的成人糖尿病患者 390 例,对患者进行问卷调查并检测糖化血 红蛋白(HbA1c)。按年龄进行分组,青中年组为< 60 岁患者,老年组为≥ 60 岁患者。问卷调查内容包括性别、年龄、 糖尿病病程、糖尿病分型、药物治疗、血糖监测以及其他病史等。结果:患者以中老年女性患者为主,男性占比 45.4 %; 平均年龄(57.7 ± 9.7)岁;体型超重,平均身体质量指数(BMI)(25.1 ± 3.6)kg·m–2,伴中心性肥胖,平均腰围 (88.2 ± 9.8)cm;平均糖尿病病程(6.2 ± 5.2)年。平均 HbA1c(7.2 ± 4.0)%,HbA1c 达标率为 59.2 %。99.5 % 患 者均属于 2 型糖尿病。89.0 % 的患者正在接受药物治疗,口服降糖药主要为二甲双胍、胰岛素促泌剂、α– 糖苷酶抑制。 85.1 % 患者表示曾接收过糖尿病教育。67.2 % 患者表示会进行自我血糖监测(SMBG)。30.1 % 患者表示每年会监 测 HbA1c。34.4 % 的患者合并有高血脂病史,8.7 % 合并有冠心病、4.1 % 合并有脑卒中。28.2 % 的患者血压控制不 佳。从年龄分组看,青中年组患者占比约 60 %(57.4 %)。青中年组和老年组在体型、HbA1c 达标、糖尿病药物治疗、 糖尿病教育、血糖监测及血压控制不佳情况方面差异均无统计学意义(P > 0.05)。但老年组患者在糖尿病病程、合 并症病史占比及吸烟饮酒史方占比面较青中年组更高,差异具有统计学意义(P < 0.05)。结论:本研究首次呈现了 大鹏社区糖尿病管理方面较高 HbA1c 达标率和糖尿病教育率,未来大鹏社区还需进一步加强全科医生进修学习,依 据最新指南应用新型口服降糖药物、增加糖尿病患教质量和糖尿病患者教育与支持力度,促进大鹏社区糖尿病患者管 理水平的进一步提升。

    Abstract:

    〔Abstract〕 Objective Through the investigation of adult diabetics in the large community health service centers of Shenzhen Dapeng new district (hereinafter referred to as Dapeng community), to understand the current situation of medical care of diabetics in Dapeng community, and to provide data support for chronic disease management decision–making provided by Shenzhen Dapeng New District Government and Medical Group. Methods A total of 390 adult diabetics from 7 Dapeng communities from April 2019 to April 2021 were included in the study. A questionnaire survey was conducted and glycosylated hemoglobin (HbA1c) was detected. The patients were divided into two groups according to age: the young and middle-aged group was < 60 years old, and the elderly group was ≥ 60 years old. The questionnaire included gender, age, diabetes course, type of diabetes, medication, blood glucose monitoring and other medical history. Results The patients were mainly middle-aged and elderly female patients male accounted for 45.4 %; The mean age was (57.7 ± 9.7) years; Overweight, average body mass index (BMI) (25.1 ± 3.6) kg·m-2, accompanied by central obesity, average waist circumference (88.2 ± 9.8) cm; The mean duration of diabetes was (6.2 ± 5.2) years.The average HbAlc was (7.2 ± 4.0)% and the standard rate of HbA1c was 59.2%. Almost all patients (99.5%) were type 2 diabetes. 89.0% patients were receiving drug treatment, and oral hypoglycemic agents were mainly metformin, insulin–secreting agent, and α–glycosidase inhibition. 85.1% of the patients said they had received diabetes education. 67.2% of patients said they would conduct self– monitoring of blood glucose (SMBG). 30.1% percent of patients reported monitoring HbA1c annually. 34.4% patients had a history of hyperlipidemia, 8.7% had coronary heart disease and 4.1% had stroke. 28.2% patients had poor blood pressure control. From the age group, the proportion of young and middle–aged group patients was 57.4%. There was no significant difference in somatotype, standard rate of HbA1c, diabetes drug treatment, diabetes education, blood glucose monitoring and poor blood pressure control between the young and middle–aged group and the elderly group (P > 0.05). However, the proportion of the course of diabetes, the history of complications and the history of smoking and drinking in the elderly group was higher than that in the young and middle_x0002_aged group (P < 0.05). Conclusion This study for the first time showed a high standard rate of HbA1c and diabetes education rate in Dapeng community in diabetes management. In the future, Dapeng community needs to further strengthen the study of general practitioners, apply new oral hypoglycemic drugs according to the latest guidelines, increase the quality of diabetes education and support for diabetes patients, and further improve the management level of diabetes patients in Dapeng community.

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  • 收稿日期:2021-10-18
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  • 在线发布日期: 2022-04-18
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