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1、2型糖尿病临床路径管理初探2型糖尿病临床路径管理初探中图分类号:R587.1文献标识码:A文章编号:1009_816X(2010)02_0097_03InvestigationontheEffectivityofManagementofClinicalPathwayinType2DiabetesPatients.NINGFan,ZENGWenheng,TANGKeke,etal.DepartmentofEndocrinology,SecondAffi1iatedHospitalofMedicalSchool,ZhejiangUniversity,Zhejiang310009,
2、China[Abstract]ObjectiveToobservetheeffectoftheclinicalmanagementpathwayontheglycemiccontrolandpancreaticBcellfunctionintype2diabetespatients.MethodsAnopencontrolledrealityresearchmethodwasadoptedinthisstudy.AccordingtoCDSguideline,107Outpatientswithtype2diabetesweredividedintotwogroups・Gro
3、upA:BMI224Kg/m❷2,metforminplusinsulinsensitizeragentwasused,andgroupB:BMIW24Kg/m❷2,metforminplusinsulinsecretionpromotingagentswasused.Theaveragefollowupwas1.5years・Thefastingbloodglucose(FBG),2hourspostprandialbloodglucose(2hPBG),glycosylatedhemoglobinAle(HbAlc),fastinginsulin(FINS),2hours
4、postprandialinsulin(2hINS)、serumlipids(TG,LDLC,andHDLC),HOMAIR,HOMAIS,andHOMAIAIwerecomparedbetweenbefore(baseline)andaftertreatmentfortwogroups.ResultsComparedtobaseline,thelevelsofFBG>2hPBG>HbAlcweredecreasedsignificantlyinbothgroupAandB(P<0.05)・TherateofgoodHbAlccontrol(HbAlcvalue<6.5%)w
5、assignificantlyincreased(70.37%vs55.5%ingroupA,65.96%vs4&94%ingroupB,respectively)・HOMAIAIweresignificantlyincreased(P<0.05)whileHOMA_IRdecreased(P<0.05)inGroupA.HOMA_IAIandHOMA_ISweresignificantlyincreasedwhileHOMAIRdecreased(P<0.05〜0.01)inGroupB.ConclusionsTheratesofgoodcontrolinIlbAlcand
6、pancreaticBcellfunctionweresignificantlyimprovedinpatientswithtype2diabetesmellitusunderthemanagementofclinicalpathway.[Keywords]Type2diabetesmellitus;Insulinsecretionpromotingagents;Insulinsensitizer;Managementofclinicalpathway2型糖尿病的发病率增高,血糖的达标率低已成为目前糖尿病干预治疗的难题。木文以糖尿病指南为基础,建立糖尿病临床路径为管理模式,对
7、2型糖尿病患者进行长期随访干预,观察其血糖达标与胰岛功能改善的状况。1材料与方法1.1一般资料:从糖尿病管理数据库中选取2006年至2009年在木院门诊就诊,随访1・5年以上,已有二次胰岛功能随访记录的成年2型糖尿病患者107例,年龄24〜79(平均53.5±10.7)岁,诊断符合1999年WHO糖尿病诊断标准,无酮症史,平均病程(5.4±3.3)年,平均收缩压(125±20)mmHg,平均舒张压(79±10)mmHgo无合并其他影响糖代谢的疾病,如库欣综合征、甲状腺功能亢进症、肢端肥大症等。107名2