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目的评价二级医院与其下属社区卫生服务机构的2型糖尿病患者双向转诊效果。方法选取100例2型糖尿病患者进行12月的治疗,A组为干预组50例,实行医院与社区双向转诊。B组为对照组50例,为所有自发到同仁医院内分泌专科和社区就诊的糖尿病患者。观察体重指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、餐后2小时血糖(2h-PBG)、糖化血红蛋白(HbA1c)、平均动脉压(MAP)及血脂、空腹胰岛素(FIns),计算胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)变化情况。结果①两组治疗后12月的FBG,2hPG,HbA1c,MAP均显著低于治疗前(P值分别<0.05、0.01)。②治疗12月后,A组患者的血糖控制情况明显优于B组(P<0.05)。③治疗后,A组的血脂控制较治疗前具有明显改善且优于B组(P值分别<0.05、0.01)。④治疗12月后,A组患者的HOMA-IR低于B组,ISI高于B组(P值均<0.05)。⑤治疗后,A组按时复诊率,服用调脂药、阿司匹林率高于与B组(P值分别<0.01、0.05)。结论 2型糖尿病实施双向转诊有助于医疗治疗一贯性,实现良好的血糖、血压和血脂控制。
Objective To evaluate the bidirectional referral effect of type 2 diabetes patients in secondary hospitals and their subordinate community health service institutions. Methods A total of 100 type 2 diabetic patients were selected for treatment in December. Group A was treated with interventional therapy in 50 cases. Two-way referral was performed between hospital and community. Group B, a control group of 50 patients, all spontaneously to colleagues hospital endocrine specialist and community treatment of diabetic patients. Body mass index (BMI), WHR, FPG, 2h-PBG, HbA1c, mean arterial pressure (MAP) and blood fat, fasting insulin ), Calculated insulin sensitivity index (ISI), insulin resistance index (HOMA-IR) changes. Results ① The levels of FBG, 2hPG, HbA1c and MAP in the two groups after treatment were significantly lower than those before treatment (P <0.05, 0.01 respectively). ② After 12 months of treatment, patients in group A had significantly better glycemic control than those in group B (P <0.05). ③ After treatment, the blood lipid control in group A was significantly improved and better than that in group B (P <0.05, 0.01 respectively). ④ After 12 months of treatment, the HOMA-IR of group A was lower than that of group B, and the ISI was higher than that of group B (all P <0.05). ⑤ After treatment, the rate of referral on time and the dosage of lipid-lowering drugs in group A were higher than those in group B (P <0.01, 0.05 respectively). Conclusions Bi-directional referral of type 2 diabetes is helpful for consistency of medical treatment and good blood sugar, blood pressure and lipid control.