【摘要】：背景:根據(jù)國際糖尿病聯(lián)盟(International Diabetes Federation,IDF)的最新估計(jì),2015年全球約有4.15億的糖尿病(Diabetes Mellitus,DM)患者,預(yù)計(jì)在2040年將達(dá)到6.42億。中國幾次大型流行病學(xué)調(diào)查顯示,在過去30年,糖尿病患病率從1980年的0.7%快速上升至2010年的11.6%,患者人數(shù)超過歐美、印度等國家,成為全球糖尿病患者最多的國家,更值得關(guān)注的是,中國18歲及以上成年人處于糖尿病前期(Prediabetes,PDM)的比例高達(dá)50.1%。如果不加以任何干預(yù),每年將有5~10%的糖尿病前期患者發(fā)展為糖尿病。糖尿病已成為21世紀(jì)全球最重要的公共衛(wèi)生問題之一,尤其是2型糖尿病(Type 2 diabetes,T2DM)的防治面臨著前所未有的挑戰(zhàn)。糖尿病的預(yù)防與控制技術(shù)得到世界衛(wèi)生組織(World Health Organization,WHO)和各國政府的高度關(guān)注。除了藥物治療,大量研究證實(shí)行為干預(yù)有助于患者的血糖控制,根據(jù)中國《2型糖尿病患者健康管理服務(wù)規(guī)范》要求,目前,中國所有確診的T2DM患者均接受基層醫(yī)療衛(wèi)生機(jī)構(gòu)提供的綜合干預(yù)。如何提高干預(yù)效力,進(jìn)一步提升干預(yù)效果成了干預(yù)研究的關(guān)鍵點(diǎn)和難點(diǎn)。近年來,一些整合社會人際資源和社會技術(shù)平臺的方法在糖尿病干預(yù)中展示出良好的應(yīng)用前景,其中同伴支持、結(jié)合互聯(lián)網(wǎng)和電訊網(wǎng)絡(luò)的信息發(fā)布與聯(lián)系的新模式在提高患者依從性、節(jié)省資源方面獨(dú)具特色。目的:1)評估現(xiàn)行社區(qū)為基礎(chǔ)的2型糖尿病綜合干預(yù)模式在大人群中運(yùn)用的可行性和有效性。2)科學(xué)合理地評價(jià)同伴支持對2型糖尿病患者血糖控制的實(shí)施效果,為后續(xù)研究提供理論基礎(chǔ)。3)完成以同伴支持、信息技術(shù)平臺為基礎(chǔ)的糖尿病前期患者行為干預(yù)模型的基礎(chǔ)構(gòu)建。方法:1)對重慶市7200例T2DM患者按照《2型糖尿病患者健康管理服務(wù)規(guī)范》要求進(jìn)行為期1年的社區(qū)為基礎(chǔ)的綜合干預(yù),通過干預(yù)前后各項(xiàng)評估指標(biāo)的改變對實(shí)施效果進(jìn)行評估。評估指標(biāo)包括空腹血糖(fastingplasmaglucose,fpg)、血糖控制達(dá)標(biāo)率,以及糖尿病防治相關(guān)知識、態(tài)度和行為(knowledgeattitudepractice,kap)等。2)系統(tǒng)性地檢索“相關(guān)期刊論文”、“中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫”、vip、medline,embase,cochranecollaborativedatabase等數(shù)據(jù)庫,搜素同伴支持進(jìn)行t2dm干預(yù)的隨機(jī)對照研究(randomizedcontrolledtrial,rct),用meta分析方法進(jìn)行數(shù)據(jù)的合并。采用cochrane協(xié)作網(wǎng)的偏倚風(fēng)險(xiǎn)評價(jià)工具對納入的所有隨機(jī)對照研究進(jìn)行風(fēng)險(xiǎn)評估,使用reviewmanager5.2和stataversion12.1軟件進(jìn)行統(tǒng)計(jì)分析,以干預(yù)組和對照組干預(yù)前后糖化血紅蛋白(glycatedhemoglobina1c,hba1c)變化值的差值(即平均差),及其95%可信區(qū)間(95%confidenceinterval,95%ci)作為判定同伴支持干預(yù)效果的評價(jià)指標(biāo)。根據(jù)研究地區(qū)、研究對象基線hba1c水平、干預(yù)時(shí)間、干預(yù)頻率、干預(yù)模式等進(jìn)行亞組分析。3)根據(jù)行為干預(yù)理論構(gòu)建新型糖尿病前期患者行為干預(yù)模型;通過定性研究構(gòu)建行為干預(yù)任務(wù)、內(nèi)容;在有代表性的社區(qū)建立干預(yù)隊(duì)列;干預(yù)組建立以同伴支持和信息化技術(shù)為基礎(chǔ)的干預(yù)網(wǎng)絡(luò)。進(jìn)一步觀察干預(yù)組與對照組的可比性為前瞻性觀察提供依據(jù);在干預(yù)模型基礎(chǔ)建設(shè)完成的同時(shí),初步觀察干預(yù)隊(duì)列的行為轉(zhuǎn)變,了解其依從性。結(jié)果:1)6586名t2dm患者完整的接受了1年的社區(qū)為基礎(chǔ)的綜合干預(yù),患者空腹血糖平均值由干預(yù)前的8.52±2.84mmol/l降至干預(yù)后的7.44±2.06mmol/l,血糖控制達(dá)標(biāo)率由27.18%顯著上升至52.82%;糖尿病防治相關(guān)知識的7項(xiàng)核心指標(biāo)知曉率從39.95%~74.83%上升至72.50~85.44%;規(guī)范化藥物治療、堅(jiān)持非藥物治療和每周堅(jiān)持1次以上血糖監(jiān)測的比例分別由19.48%、19.02%和18.78%上升到75.19%、67.42%和41.62%。接受干預(yù)后,農(nóng)村地區(qū)和小學(xué)及以下文化程度患者空腹血糖平均值分別為7.77mmol/l±2.27mmol/l和7.60mmol/l±2.21mmol/l,顯著高于城市和初中及以上文化程度的患者;血糖控制達(dá)標(biāo)率分別為44.8%和49.7%,顯著低于城市和初中及以上文化程度的患者。2)共檢索3223篇文獻(xiàn),最終納入13篇同伴支持進(jìn)行t2dm干預(yù)的隨機(jī)對照研究,涉及1352名研究對象。meta分析結(jié)果顯示:各研究間存在高度異質(zhì)性(i2=80.0%),因此選用隨機(jī)效應(yīng)模型進(jìn)行結(jié)果的合并。干預(yù)前后,干預(yù)組hba1c的改變值顯著高于對照組的改變值:平均差為-0.57(95%ci-0.78~-0.36),差異有統(tǒng)計(jì)學(xué)意義(p0.001)。亞組分析結(jié)果顯示:干預(yù)前hba1c處于高(≥8.5%)、中水平(7.5%~8.5%)的研究對象接受干預(yù)后,hba1c改變值高于對照組干預(yù)前后的改變值,平均差分別為-0.78(-1.06~-0.51)和-0.76(-1.05~-0.47),而干預(yù)前hba1c水平較低者(7.5%),干預(yù)組和對照組干預(yù)前后hba1c改變值差異無統(tǒng)計(jì)學(xué)意義,平均差為-0.08(-0.32~0.16);在干預(yù)頻率方面,實(shí)施中、高頻率的干預(yù)(1-2次/月或≥2次/月)均顯示出干預(yù)組hba1c降低值明顯高于對照組,平均差分別為-0.52(-0.60~-0.44)和-0.75(-1.21~-0.29),但低頻率的干預(yù)(1次/月)則顯示干預(yù)組與對照組干預(yù)前后hba1c改變值差異無統(tǒng)計(jì)學(xué)差異,平均差為-0.32(-0.74~0.09);干預(yù)方式方面,個(gè)體化的干預(yù)實(shí)施效果(平均差為-0.91)顯著高于群體性(平均差為-0.42)或混合性(平均差為0.52)的干預(yù)方式,大部分個(gè)體化干預(yù)項(xiàng)目均由同伴支持者通過電話或短信方式實(shí)施干預(yù);根據(jù)發(fā)表年份、干預(yù)模式、研究實(shí)施地點(diǎn)以及干預(yù)持續(xù)時(shí)間等進(jìn)行亞組分析,各亞組間差異均無統(tǒng)計(jì)學(xué)意義。3)設(shè)計(jì)了有針對性的行為干預(yù)菜單(即干預(yù)包),涉及運(yùn)動(dòng)、飲食、養(yǎng)身3個(gè)主題,10個(gè)具體行為任務(wù);建立研究隊(duì)列包括干預(yù)組285人,對照組237人;對干預(yù)組建立了涉及社區(qū)工作人員、家屬、患者同伴、健康伴鈴4層的“同伴支持”網(wǎng)絡(luò),以及整合電話、短信、qq、微信等技術(shù)手段的信息交流平臺。分析結(jié)果顯示,兩組研究對象在文化、經(jīng)濟(jì)、性別、年齡構(gòu)成、基礎(chǔ)血糖、血脂水平等指標(biāo)上具有可比性;經(jīng)過連續(xù)8周的干預(yù),干預(yù)組研究對象部分行為指標(biāo)顯著改善。結(jié)論:1)對t2dm患者實(shí)施為期1年的社區(qū)為基礎(chǔ)的綜合管理,有效降低了患者空腹血糖水平,提高了血糖控制達(dá)標(biāo)率,但總體控制率仍偏低。應(yīng)進(jìn)一步加大工作力度,探索新措施來彌補(bǔ)現(xiàn)有綜合管理模式的不足,整體推進(jìn)t2dm防治工作。2)目前的綜合管理項(xiàng)目實(shí)施效果受到多種因素的影響。與城市和文化程度較高的患者相比,農(nóng)村地區(qū)和文化程度偏低的糖尿病患者血糖水平更高、防治知識匱乏、規(guī)范化藥物治療和非藥物治療以及堅(jiān)持血糖監(jiān)測的比例更低。因此,對不同人群應(yīng)該適當(dāng)調(diào)整干預(yù)策略和方式。3)同伴支持干預(yù)模式在世界范圍內(nèi)展示出良好的應(yīng)用前景,能促進(jìn)t2dm患者h(yuǎn)ba1c水平降低,患者基礎(chǔ)hba1c水平以及干預(yù)頻率的高低是影響干預(yù)效果的重要因素。為提高同伴支持的干預(yù)效果,應(yīng)優(yōu)先選擇在血糖控制不良的t2dm患者中進(jìn)行干預(yù),且干預(yù)頻率至少達(dá)到1次/月以上。研究中發(fā)現(xiàn)的以電話或手機(jī)短信為基礎(chǔ)的干預(yù)模式可能是今后降低糖尿病患者血糖控制成本的有效手段。4)結(jié)合多重同伴支持及信息交流網(wǎng)絡(luò)的新型干預(yù)方法,整合了現(xiàn)有社會支持和資源,節(jié)省人力、物力,糖尿病前期人群接受程度較好。進(jìn)一步的效果評估將為重慶地區(qū)糖尿病防控的新型干預(yù)技術(shù)提供決策支持。5)預(yù)防糖尿病的主觀意識薄弱,行為依從性差是糖尿病前期患者的重要特征。利用條件成熟、易于實(shí)現(xiàn)的行為干預(yù)內(nèi)容,或者對重要行為干預(yù)內(nèi)容設(shè)計(jì)更為細(xì)致的作用環(huán)節(jié)是提高依從性的可行方法。此外,以糖尿病患者家庭為核心,將其中的前期患者納入干預(yù)隊(duì)列有利于提高干預(yù)效率。
[Abstract]:Background: according to the latest estimates of the International Diabetes Federation (IDF), about 415 million of the world's Diabetes Mellitus (DM) patients worldwide in 2015 are expected to reach 642 million in 2040. Several large epidemiological surveys in China have shown that the prevalence of diabetes has risen from 0.7% to 20 in the last 30 years in the last 30 years. 10 years of 11.6%, the number of patients over the United States and Europe, India and other countries, the world's most diabetic countries, more attention is that China's 18 years and older adults in the prediabetes (Prediabetes, PDM) in the proportion of up to 50.1%. if no intervention, each year will have 5~10% diabetic patients to develop diabetes. Urinary disease has become one of the most important public health problems in the world in the twenty-first Century, especially the prevention and control of type 2 diabetes (Type 2 diabetes, T2DM). The technology of prevention and control of diabetes is highly concerned by the WHO (World Health Organization, WHO) and the governments of all countries. According to the requirements of the standard of health management service for patients with type <2 diabetes in China, all of the confirmed T2DM patients in China accept the comprehensive intervention provided by the grass-roots medical and health institutions. How to improve the effectiveness of intervention and further raise the effect of intervention has become the key point and difficulty of intervention research. In recent years, some methods of integrating social interpersonal resources and social technology platform have shown good prospects for the application of diabetes intervention. The new model of peer support and information release and contact with Internet and telecommunications networks is unique in improving patient compliance and saving resources. Objective: 1) assessment of the current community Based on the feasibility and effectiveness of the integrated intervention model of type 2 diabetes in the large population (.2), a scientific and rational evaluation of the effect of peer support on blood glucose control in patients with type 2 diabetes and a theoretical basis for follow-up study.3) to complete the behavioral intervention model of prediabetes patients based on the peer support and information technology platform Basic construction. Methods: 1) 7200 cases of T2DM patients in Chongqing were given a comprehensive community based intervention based on the standard of health management service for type <2 diabetic patients for a period of 1 years. The effect was evaluated by the changes of the evaluation indexes before and after intervention. The evaluation index included fastingplasmaglucose (FPG) and blood sugar. Control the standard rate, and diabetes prevention and control related knowledge, attitude and behavior (knowledgeattitudepractice, KAP) and other.2) systematically retrieving the "Chinese journal full text database", "Chinese Biomedical Literature Database", VIP, MEDLINE, EMBASE, cochranecollaborativedatabase and other databases, search for peer support for the randomness of T2DM intervention The control study (randomizedcontrolledtrial, RCT) was used to combine the data with the meta analysis method. All the randomized controlled studies were evaluated by the bias risk assessment tool of the Cochrane Collaboration Network, and the reviewmanager5.2 and stataversion12.1 software were used for statistical analysis to make the intervention group and the control group glycated before and after intervention. The difference value (glycatedhemoglobina1c, HbA1c) variation value (mean difference), and its 95% confidence interval (95%confidenceinterval, 95%ci) were used as evaluation indexes to determine the effect of peer support intervention. According to the study area, the baseline HbA1c level, intervention time, intervention frequency, intervention model, and other subgroup analysis.3) based on the behavior according to the study area. The intervention theory was established for the behavior intervention model of the new-type prediabetes patients; the intervention task was constructed by qualitative research; the intervention queue was set up in the representative community; the intervention group established the intervention network based on peer support and information technology. Supply basis; at the same time in the completion of the intervention model construction, a preliminary observation of the behavior change of the intervention cohort and understanding of its compliance. Results: 1) 6586 T2DM patients received a complete comprehensive intervention based on 1 years of community. The average value of fasting blood glucose decreased from 8.52 + 2.84mmol/l before intervention to 7.44 + 2.06mmol/l after intervention, and the blood glucose control was controlled. The standard rate increased from 27.18% to 52.82%; the awareness rate of 7 core indicators for diabetes prevention and control increased from 39.95%~74.83% to 72.50~85.44%; standardized drug treatment, non drug therapy, and the percentage of persisting more than 1 times per week increased from 19.48%, 19.02% and 18.78% to 75.19%, 67.42% and 41.62%., respectively. After that, the average fasting blood glucose of patients in rural areas and primary schools and below was 7.77mmol/l + 2.27mmol/l and 7.60mmol/l + 2.21mmol/l, respectively, which were significantly higher than those of urban and junior high school or above. The standard rate of blood glucose control was 44.8% and 49.7% respectively, which was significantly lower than those of urban and junior high school and above education. A randomized controlled study of 13 peer support for T2DM intervention was included in 3223 papers. The results of.Meta analysis of 1352 subjects showed that there was a high heterogeneity (i2=80.0%) in each study, so the random effect model was used to merge the results. The change value of HbA1c in the intervention group was significantly higher than that of the control group before and after intervention. The mean difference was -0.57 (95%ci-0.78~-0.36), and the difference was statistically significant (p0.001). The results of subgroup analysis showed that before intervention, HbA1c was higher (more than 8.5%), and the middle level (7.5%~8.5%) subjects received the dry prognosis. The change values of HbA1c were higher than those of the control group before and after intervention, the average difference was -0.78 (-1.06~-0.51) and -0.76 (-1.05~-0.47), respectively. Before and after intervention (7.5%), there was no significant difference in HbA1c change values between the intervention group and the control group before and after intervention, the mean difference was -0.08 (-0.32~0.16). In the frequency of intervention, the intervention of high frequency (1-2 / month or more than 2 times / month) showed that the HbA1c reduction of the intervention group was significantly higher than that of the control group, and the mean difference was -0.52 (-0.6, -0.6, respectively, -0.6). 0~-0.44) and -0.75 (-1.21~-0.29), but low frequency intervention (1 / month) showed that there was no statistical difference between the intervention group and the control group before and after the intervention, and the mean difference was -0.32 (-0.74~0.09). The individual intervention effect (Ping Juncha -0.91) was significantly higher than that of the group (mean difference -0.42) or mixed sex (mean difference). The difference was 0.52). Most of the individual intervention programs were intervened by the partner supporters by telephone or SMS. According to the published years, the intervention model, the study site and the duration of the intervention, the subgroups were analyzed, and the different subgroups were all without the.3). The intervention package, involving 3 subjects of exercise, diet and health care, 10 specific behavioral tasks, and the establishment of a study cohort including 285 people in the intervention group and a control group of 237, established a "peer support" network involving the community staff, family members, patient partners, and healthy companion bell 4 layers, as well as the integrated telephone, SMS, QQ, WeChat and other technical means. The results showed that the two groups of subjects were comparable in cultural, economic, gender, age, basic blood glucose and blood lipid levels. After 8 weeks of intervention, the behavioral indicators of the subjects were significantly improved. Conclusion: 1) the implementation of a comprehensive management based on the community for a period of 1 years for T2DM patients was effective. Reduce the level of fasting blood glucose in patients, improve the rate of blood glucose control, but the overall control rate is still low. We should further strengthen the work, explore new measures to make up the deficiency of the existing comprehensive management model, and promote the overall T2DM prevention and control work.2) the current comprehensive management project effect is affected by a variety of factors, and the city and culture. Higher levels of patients have higher levels of blood sugar in rural and less educated diabetics, lack of knowledge of prevention and control, standardized drug treatment and non drug treatment, and the lower proportion of adherence to blood glucose monitoring. Therefore, the intervention strategy and.3 of different populations should be properly adjusted and the peer support intervention model is worldwide The good prospect of application can promote the decrease of HbA1c level in T2DM patients. The level of basic HbA1c and the frequency of intervention are important factors that affect the effect of intervention. In order to improve the intervention effect of peer support, priority should be given to intervention in T2DM patients with poor blood glucose control, and the frequency of intervention is at least 1 times per month. The intervention model based on telephone or cell phone SMS may be an effective means to reduce the cost of diabetes control in the future,.4) combined with the new intervention method of multiple peer support and information communication network, integrating the existing social support and resources, saving manpower, material resources, and the acceptance of pre diabetes population. Better. Further evaluation will provide decision support for the new intervention technologies for diabetes prevention and control in Chongqing. The subjective awareness of diabetes prevention is weak. Poor compliance is an important feature of pre diabetes patients. Use of mature, easy to implement behavior intervention, or more important behavior intervention content design more. Careful action is a feasible way to improve compliance. In addition, the inclusion of early patients in the intervention cohort in the family of diabetic patients is beneficial to the improvement of the intervention efficiency.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R587.1

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3 顧芹,宋守君,李向陽,尤傳一;胰激肽原酶腸溶片對早期糖尿病腎病的防治作用[J];中國臨床藥學(xué)雜志;2001年06期

4 曹愛華 ,王瑛 ,李翔;杏丁治療早期糖尿病腎病療效觀察[J];遼寧實(shí)用糖尿病雜志;2001年03期

5 ;中藥治療糖尿病腎病新進(jìn)展[J];中國中醫(yī)藥信息雜志;2001年04期

6 張桂茹;糖尿病腎病85例臨床分析[J];陜西醫(yī)學(xué)雜志;2002年02期

7 侯建明 ,林鳳輝 ,張超群;46例2型糖尿病腎病與糖尿病自主神經(jīng)病變的關(guān)系分析[J];福建醫(yī)藥雜志;2002年04期

8 陳文霖;糖尿病飲食[J];醫(yī)療保健器具;2002年Z1期

9 孫力,許玲;2型糖尿病患者糖尿病足的危險(xiǎn)因素分析[J];山東醫(yī)藥;2002年35期

10 ;糖尿病腎病診治研究進(jìn)展[J];基礎(chǔ)醫(yī)學(xué)與臨床;2003年04期

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4 張文鎧;王志伏;王雪;孫大朋;;糖尿病腎病的治療現(xiàn)狀[A];中華中醫(yī)藥學(xué)會第二十一屆全國中醫(yī)腎病學(xué)術(shù)會議論文匯編（下）[C];2008年

5 倪青;;糖尿病腎病的中西醫(yī)結(jié)合研究[A];第六屆全國中西醫(yī)結(jié)合腎臟病學(xué)術(shù)會議論文匯編[C];2000年

6 孫怡;李健紅;宗紅燕;;黃芪桂枝五物湯加味治療糖尿病腎病16例[A];第六屆全國中西醫(yī)結(jié)合腎臟病學(xué)術(shù)會議論文匯編[C];2000年

7 葉軍;;糖尿病腎病在兒童時(shí)期的早期干預(yù)[A];中華醫(yī)學(xué)會第六次全國內(nèi)分泌學(xué)術(shù)會議論文匯編[C];2001年

8 杜旭昶;孫志紅;閆春芳;劉彩虹;;疏糖丹治療2型糖尿病50例臨床分析[A];第六次中國中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會議論文匯編[C];2002年

9 于世家;任平;馬麗佳;李小娟;鄭曙琴;武明東;劉自力;薛麗輝;;糖尿病住院患者1344例回顧性分析[A];第六次中國中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會議論文匯編[C];2002年

10 郝效槐;魏玫都;崔立俊;;中西并蓄治療糖尿病腎病[A];第七次中國中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會議論文匯編[C];2004年

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5 王文絹 范軍星;世界糖尿病日關(guān)注焦點(diǎn):糖尿病并發(fā)癥[N];健康報(bào);2003年

6 主持人 向紅丁博士;糖尿病腎病須早防早治[N];人民政協(xié)報(bào);2002年

7 華悅;預(yù)防糖尿病，，從減肥開始[N];上海中醫(yī)藥報(bào);2004年

8 劉冬梅;肥胖糖尿病第一誘因[N];天津日報(bào);2004年

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7 姜e

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