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目的评价社区早期糖尿病肾病综合干预效果。方法采用随机对照方法,将201名社区早期糖尿病肾病患者随机分为干预组和对照组,干预组接受糖尿病肾病社区综合干预和规范化管理,对照组接受常规的糖尿病管理。比较两组患者在项目实施前和实施12个月后的指标变化情况。结果干预12个月后,干预组在对疾病的认知、态度及自我管理行为方面的得分明显优于对照组,其中疾病知识认知较对照组多增加了1.20分,疾病相关态度较对照组多增加了0.52分,服药依从性、周锻炼次数、医患交流分别较对照组多增加了0.19分、0.74次/周和0.44分(P均<0.05)。干预组餐后2 h血糖、糖化血红蛋白较对照组多下降1.13 mmol/L和0.42%,尿微量白蛋白/尿肌酐较对照组多下降26.81 mg/g,收缩压较对照组多下降3 mm Hg(P均<0.05)。结论规范的社区综合干预较常规的糖尿病管理能更明显提高早期糖尿病肾病患者的疾病认知、态度和自我管理行为,更好地改善尿微量白蛋白/尿肌酐、餐后血糖和血压等生物学指标。
Objective To evaluate the effect of early intervention in diabetic nephropathy in community. Methods A total of 201 patients with early diabetic nephropathy in community were randomly divided into intervention group and control group. The intervention group received comprehensive community intervention and standardized management of diabetic nephropathy. The control group received routine diabetes management. The changes of the indexes before and 12 months after the implementation of the project were compared between the two groups. Results After intervention for 12 months, the score of intervention group was significantly better than that of control group in cognition, attitude and self-management behavior of disease, in which the awareness of disease knowledge increased by 1.20 points more than that of control group, and disease-related attitude was higher than that of control group Increased by 0.52 points, medication compliance, weekly exercise times, doctor-patient exchanges were increased by 0.19 points compared with the control group, 0.74 times / week and 0.44 points (all P <0.05). In the intervention group, the levels of blood glucose and HbA1c decreased 1.13 mmol / L and 0.42% more than those in the control group at 2 h postprandial, the urinary albumin / urinary creatinine decreased 26.81 mg / g more than the control group, and the systolic blood pressure decreased 3 mm Hg (P <0.05). Conclusion Standardized community-based interventions can significantly improve disease cognition, attitude and self-management behavior in patients with early stage diabetic nephropathy as compared with conventional diabetes management and improve the biology of urinary microalbuminuria, urinary creatinine, postprandial blood glucose and blood pressure index.