移动医疗对使用胰岛素治疗糖尿病患者的管理效果

钱彩凤 覃晓东 梁卓林 黎敏姬

[摘要]目的 探讨移动医疗对使用胰岛素治疗糖尿病患者的管理效果。方法 选取2016年4月～2017年7月我院内分泌科使用胰岛素治疗的182例糖尿病患者作为研究对象，按照就诊顺序的奇偶性将其随机分为治疗组及对照组，每组各91例。治疗组纳入康赛移动慢病管理平台，在患者或家属的移动终端下载APP，并生成个人档案，记录患者的治疗方案，血糖监测情况等，实施动态异常提醒，及时提醒患者调整胰岛素用量，随时进行健康教育。对照组选用传统就医方式，普通门诊随诊。3个月后，比较两组患者的血糖监测次数、胰岛素用量调整频率、低血糖发生率、复诊比例，比较两组患者治疗前后的血糖达标率、糖化血红蛋白水平的变化。结果 治疗组患者的血糖监测次数（>3次/d）、胰岛素用量调整频率（>1次/周）、复诊比例明显高于对照组，低血糖发生率明显低于对照组，差异均有统计学意义（P<0.05）。3个月后，治疗组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白水平显著低于对照组，差异有统计学意义（P<0.05）。结论 移动医疗能有效提高医生对使用胰岛素治疗糖尿病患者的管理能力，能够明显改善患者的血糖水平。

[關键词]移动医疗；胰岛素；糖尿病；医生管理

[中图分类号] R587.1 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0054-03

Management effect of mHealth on diabetics treated with Insulin

QIAN Cai-feng QIN Xiao-dong LIANG Zhuo-lin LI Min-ji

Department of Endocrinology，People′s Hospital of Gaoyao District in Zhaoqing City，Guangdong Province，Zhaoqing 526040，China

[Abstract]Objective To explore the management effect of mHealth in diabetic patients treated with Insulin.Methods A total of 182 patients with diabetes mellitus （DM） treated with Insulin from department of endocrinology in our hospital from April 2016 to July 2017 were selected as subjects.They were randomly divided into treatment group and control group according to the parity of treatment order，with 91 cases in each group.In the treatment group，Kangsai mobile disease management platform was used.To be specific，the APP was downloaded and installed in the mobile terminal of the patient or family.The personal file was established，the patient′s therapeutic regimen was recorded and blood glucose was monitored.Dynamic abnormality alert was implemented to prompt the patient to adjust the insulin dosage in time and guide the health education at any time.In the control group，traditional method of medical treatment was used，and follow-up visit was carried out in general out-patient clinics.After 3 months，the frequency of blood glucose monitoring，the frequency of insulin dosage adjustment，the incidence of hypoglycemia，and the proportion of return visits were compared between the two groups.The rate of blood glucose reaching the standard and changes of glycosylated hemoglobin levels before and after treatment were compared.Results In the treatment group，the proportions of blood glucose monitoring over 3 times/d，dosage of Insulin adjustment frequency over once a week and return visits were significantly higher than those in the control group，and the incidence of hypoglycemia was much lower than that in the control group，the differences were statistically significant （P<0.05）.Compared with the control group，the fasting blood glucose，2 h-postprandial blood glucose，and glycosylated hemoglobin were significantly lower in the treatment group than those in the control group after 3-month treatment，the differences were statistically significant （P<0.05）.Conclusion mHealth can effectively improve physician′s management ability to use Insulin to treat DM patients and remarkably ameliorate their blood glucose levels.

[Key words]mHealth；Insulin；Diabetes mellitus；Physician management

社会物质文明的进步，对人类的作息规律、饮食习惯、生活环境、人均寿命都发生了巨大的影响，必然导致了疾病谱的改变。近30年来，我国的糖尿病患病率显著增加[1]，糖尿病已成为我国最常见的慢性疾病之一，《中国糖尿病防治指南》（2013版）指出，应用世界卫生组织（WHO）1999年的诊断标准，中国18岁以上人群糖尿病患病率为9.7%，城镇患病率达11.6%[2]。2015年，我国预计已有1.096亿人罹患糖尿病。与此同时，我国糖尿病控制达标情况并不理想，胰岛素是目前降血糖作用最强和使用经验最丰富的药物[3]，但应用胰岛素的患者达标率更低。《中……