广西医学

目的评价多元规范化管理体系在改善2型糖尿病（T2DM）患者糖脂代谢水平中的应用效果。方法选取668例T2DM患者作为研究对象。所有患者出院后均在常规干预的基础上接受专业健康管理干预。比较患者干预前（T0）与干预后1~<3个月（T1）、3~<6个月（T2）、6~<12个月（T3）、12~<18个月（T4）、≥18个月（T5）糖脂代谢指标水平，包括HbA1c、空腹血糖（FBG）、餐后2 h血糖（2hPBG）、总胆固醇（TC）、甘油三酯（TG）、HDL⁃C、LDL⁃C。在不同性别、年龄患者中比较干预前后糖脂代谢指标水平，并比较不同年龄、性别、干预频次患者糖脂代谢指标改变量（∆）。结果（1）总体上，T2DM患者T1~T5的HbA1c、2hPBG、TC、LDL⁃C水平均低于T0，T1~T2的TG水平低于T0，T1~T4的HDL⁃C水平均高于T0（P<0.05）。（2）无论是男性患者还是女性患者，干预后多数时点的HbA1c、2hPBG、TC、TG、LDL⁃C水平低于T0，HDL⁃C水平高于T0（P<0.05）；男性患者T1、T2、T4、T5的∆HbA1c和T1的∆2hPBG大于女性患者（P<0.05）。（3）在≤60岁患者中，多数时间点HbA1c、2hPBG、TC、TG和LDL⁃C水平低于T0，HDL⁃C水平高于T0（P<0.05）；在>60岁患者中，多数时间点HbA1c、2hPBG、LDL⁃C水平低于T0，FBG、HDL⁃C水平高于T0（P<0.05）；≤60岁患者T1~T3、T5的∆HbA1c，以及T2的∆TG和∆LDL⁃C大于>60岁患者（P<0.05）。（4）干预频率低组T5的∆HbA1c（两组均>0）、T5的∆TG（干预频率低组>0、干预频率高组<0）、T4的∆FBG（两组均<0）大于干预频率高组（P<0.05）。结论多元规范化管理体系能有效地改善T2DM患者的糖脂代谢水平，具有良好的推广价值。不同性别、年龄、干预频率的患者均可从该管理体系中不同程度的获益，而男性患者、≤60岁患者、低干预频率的患者可能获益更多。

Objective To evaluate the application effect of a diversified standardized management system in the improvement of glucose and lipid metabolism levels in patients with type 2 diabetes mellitus (T2DM). Methods A total of 668 T2DM patients were selected as the research subjects. All patients received professional healthy management intervention based on routine intervention after discharge. Glucose and lipid metabolism indicator levels, including HbA1c, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPBG), total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C were compared between patients before intervention (T0), and 1-<3 months (T1), 3-<6 months (T2), 6-<12 months (T3), 12-<18 months (T4), ≥18 months (T5) after intervention. Glucose and lipid metabolism indicator levels were compared between patients with different genders and ages before and after intervention, and change in glucose and lipid metabolism indicators (∆) was compared between patients with different ages, genders and intervention frequencies. Results (1) Generally, HbA1c, 2hPBG, TC, and LDL-C levels of T2DM patients were lower at time points T1-T5 than at time point T0, TG level was lower at time points T1-T2 than at time point T0, whereas HDL-C level was higher at time ponts T1-T4 than at time point T0 (P<0.05). (2) Whether male or female patients, the levels of HbA1c, 2hPBG, TC, TG and LDL-C at most of the time points after intervention were lower than those at T0, while HDL-C level was higher than that at T0 (P<0.05). ∆HbA1c at T1, T2, T4 and T5, as well as ∆2hPBG at T1 of male patients were greater than those of female patients (P<0.05). (3) Among patients aged ≤60 years, the levels of HbA1c, 2hPBG, TC, TG and LDL-C at most of the time points were lower than those at T0, whereas HDL-C level was higher than that at T0 (P<0.05). Among patients aged >60 years, the levels of HbA1c, 2hPBG and LDL-C at the most of the time points were lower than those at T0, while FBG and HDL-C levels were higher than those at T0 (P<0.05). ∆HbA1c at T1-T3, and T5, as well as ∆TG and ∆LDL⁃C at T2 of patients aged ≤60 years were all greater than those of patients aged >60 years (P<0.05). (4) The low-frequency intervention group yielded greater ∆HbA1c (both group >0), ∆TG (the low-frequency intervention group >0 while the high-frequency intervention group <0) at T5, as well as ∆FBG (both group <0) at T4 as compared with the high-frequency intervention group (P<0.05). Conclusion The diversified standardized management system can effectively ameliorate glucose and lipid metabolism levels of T2DM patients, exerting favorable promotion values. Patients of different genders, ages, and intervention frequencies can all benefit to varying degrees from this management system, but male patients, those aged ≤60 years, and those with a lower-frequency intervention may benefit more.