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目的:探讨强化饮食运动对2型糖尿病患者的疗效和成本效果比。方法:将58例2型糖尿病患者分为两组,即干预组和对照组。干预组32例,在常规药物治疗的基础上应用《合理饮食轻松降低血糖》指导患者学会制定科学、合理的饮食方案,同时根据运动负荷试验选择《糖尿病量化运动处方》中适合患者本人的个性化运动处方。对照组26例,按照医嘱应用药物治疗,对饮食和运动只做一般的口头指导。比较两组干预前与干预后3,6,9,12个月不同时间段的血糖变化和每组干预前与干预后不同时间段的血糖变化,采用成本—效果分析方法进行卫生经济学评价。结果:干预后3,6,9,12个月时干预组的空腹血糖(FPG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)水平均显著低于干预前(P<0.01或P<0.05);对照组的2hPBG、HbA1c水平均显著低于干预前(P<0.01)。干预后3个月干预组的HbA1c为(6.52±0.92)%,明显低于对照组的(7.21±1.25)%(P<0.05);干预后6个月干预组的FPG、2hPBG、HbA1c分别为(6.10±1.17)mmol/L、(7.30±1.64)mmol/L、(6.28±0.67)%,均显著低于对照组的(7.27±2.00)mmol/L、(9.31±2.07)mmol/L、(7.25±1.05)%(P<0.05或P<0.01);干预后9个月干预组的FPG、2hPBG、HbA1c分别为(5.78±1.28)mmol/L、(7.27±2.07)mmol/L、(6.19±0.71)%,均显著低于对照组的(7.30±2.33)mmol/L、(10.22±2.53)mmol/L、(7.33±0.98)%(P<0.01);干预后12个月干预组的FPG、2hPBG、HbA1c分别为(5.75±1.27)mmol/L、(7.23±2.08)mmol/L、(6.17±0.68)%,均显著低于对照组的(6.90±2.33)mmol/L、(9.03±2.57)mmol/L、(6.97±0.98)%(P<0.05或P<0.01)。12个月来用于糖尿病的药费,干预组为(2 507.97±1 539.21)元,对照组为(3 539.53±1 901.03)元,两组比较差异有统计学意义(P<0.01),且干预组的成本—效果比值明显低于对照组。结论:强化饮食运动疗法可以更快、更平稳的控制血糖,效果显著,费用降低。
Objective: To investigate the efficacy and cost-effectiveness of intensive dietary exercise on type 2 diabetic patients. Methods: 58 cases of type 2 diabetes were divided into two groups, intervention group and control group. Intervention group of 32 cases, on the basis of conventional drug therapy, the application of “reasonable diet easily lower blood glucose” guide patients to learn to develop a scientific and reasonable diet program, at the same time, according to exercise stress test to select “diabetic quantitative exercise prescription” for the patient’s personalization Exercise prescription. The control group of 26 patients, according to the doctor’s advice on the use of medication, diet and exercise only make general oral guidance. The changes of blood glucose in different time periods before, between 3, 6, 9 and 12 months after intervention and before and after each intervention were compared between two groups. The cost-effectiveness analysis was used to evaluate the health economics. Results: The levels of FPG, 2hPBG and HbA1c in intervention groups were significantly lower than those before intervention (P <0.01 or P < 0.05). The levels of 2hPBG and HbA1c in control group were significantly lower than those before intervention (P <0.01). The level of HbA1c in intervention group was (6.52 ± 0.92)% at 3 months after intervention, which was significantly lower than that in control group (7.21 ± 1.25)% (P <0.05). FPG, 2hPBG and HbA1c in intervention group at 6 months after intervention were (6.10 ± 1.17) mmol / L and (7.30 ± 1.64) mmol / L and (6.28 ± 0.67)%, respectively, which were significantly lower than those in the control group (7.27 ± 2.00 mmol / L and 9.31 ± 2.07 mmol / L, (7.25 ± 1.05)% (P <0.05 or P <0.01). FPG, 2h PBG and HbA1c of the intervention group were (5.78 ± 1.28) mmol / L and 6.17 ± 0.71)%, which were significantly lower than those in the control group (7.30 ± 2.33 mmol / L, 10.22 ± 2.53 mmol / L, 7.33 ± 0.98%, P <0.01) The levels of FPG, 2hPBG and HbA1c were (5.75 ± 1.27) mmol / L and (7.23 ± 2.08) mmol / L and (6.17 ± 0.68)%, respectively, which were significantly lower than those in the control group (6.90 ± 2.33 mmol / L, 9.03 ± 2.57) mmol / L, (6.97 ± 0.98)% (P <0.05 or P <0.01). The cost of medication for diabetes in the 12 months was (2 507.97 ± 1 539.21) yuan in the intervention group and (3 539.53 ± 1 901.03) yuan in the control group, with significant difference between the two groups (P <0.01) The cost-effectiveness ratio of the intervention group was significantly lower than that of the control group. Conclusion: Fortified diet and exercise therapy can control blood sugar faster and more smoothly with obvious effect and lower cost.