RESUMO
Objective To assess the effect of community management of type 2 diabetes mellitus (T2DM)patients with signing on family doctor service in Shanghai.Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017.T2DM patients,who visited the community health service centers more than three times in the last one year, were enrolled in the study.The questionnaire survey was conducted and lab tests were documented.Results A total of 5 078 T2DM patients were enrolled in this study,among whom 2 033 had signed contract service with family doctors(signing group)with a signing rate of 40.8%.Compared to non-signing group,the patients in the signing group were better followed the recommendations of blood glucose control[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)], diet[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)]and physical activity[63.4%(1 295/2 053)vs.34.8%(1 033/2 978)](χ2=356.507, 400.649 and 393.996, P<0.01).The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group[80.2%(1 615/2 053)vs.77.6%(2 272/2 978), χ2=3.894,P<0.05;81.8%(1 679/2 053)vs.74.5%(2 215/2 978),χ2=38.084, P<0.05]. The control rates of GLU,2 h PPG,HbA1c,and blood pressure in signing group were higher than those in non-signing group[40.0%(823/2 053)vs.35.9%(1 069/2 978),47.3%(971/2 053)vs.45.4%(1 352/2 978),35.2%(722/2 053)vs.32.5%(968/2 978), χ2=18.495,5.218, 5.006, all P<0.05].Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low.
RESUMO
Objective To analyze the risk factors of microvascular complications in patients with type 2 diabetes mellitus (T2DM).Methods The demographic and clinical data of 5078 T2DM patients in six communities of Shanghai were collected during September 2014 to April 2015. The risk factors of microvascular complications in T 2DM were analyzed by classification tree model .Results Among 5078 T2DM patients there were 1007 cases of diabetic retinopathy (DR) (21.1%) and 1937 cases of diabetic nephropathy (DN) (38.4%).The classification tree models showed that the risk factors of DR were higher hemoglobin A1C ( HbA1c), fasting blood glucose ( FBG), postprandial blood glucose ( PBG) and triacylglycerol ( TG) levels;longer course of disease and younger age of onset .The model showed that the risk factors of DN were higher HbA1c, FBG, hypertension, PBG, body mass index ( BMI ) and triacylglycerol (TG) levels;and lower high-density lipoprotein (HDL) level.The HbA1c, course of disease and PBG were more closely related to DR and HbA 1c, hypertension and FBG were more closely related to DN.Conclusion HbA1c is the most important risk factor to microvascular complications; FBG and PBG are independent risk factors of microvascular complications;the course of disease and hypertension are risk factors of DR and DN , respectively .