[精品]2型糖尿病临床路径管理初探

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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