Evaluation on the efficacy of integrated management on elderly type 2 diabetes mellitus patients with chronic complications

Abstract

Objective To investigate the current treatment of elderly type 2 diabetes mellitus (T2DM) patients with chronic complications and assess the effect of integrated management on them,so as to provide basis for the improvement and popularization of the mode.Methods Eighty-eight elderly T2DM patients with chronic complications were selected in this study,according to the wishes of the patients,46 cases with traditional way of self-management patients as control group,and 42 cases with hospital-community-family integrated management patients as integrated group,all the patients were followed up for 1 year,all the patients were assessed with Hamilton depression scale (HAMD),Hamilton anxiety scale (HAMA) and the Adjusted Diabetes Quality-of-life Measure (A-DQOL).The fasting plasma glucose(FPG),2-hour postprandial plasma glucose (2 h PG),glycosylated hemoglobin (HbA1c),systolic blood pressure (SBP),diastolic blood pressure (DBP),total cholesterol (TC),triglyceride (TG),and low-density lipoprotein cholesterol (LDL-C) were measured,and the medical costs for treating T2DM and its complications was calculated.Results The index before management between 2 groups had no significant difference (P ＞ 0.05).After management for 1 year,the FPG,2 h PG,HbA1c,frequency of hypoglycemia per month,TC,TG,LDL-C,DBP,hospital costs,direct medical costs,HAMA scores and A-DQOL scores in integrated group were significantly lower than those in control group [(7.36 ± 1.21) mmol/L vs.(9.11 ± 1.82) mmol/L,(9.01 ± 2.14) mmol/L vs.(14.22 ± 3.23) mmol/L,(7.26 ± 1.19)％ vs.(8.84 ± 1.80)％,(0.84 ± 1.08) times/month vs.(3.13 ± 2.58) times/month,(4.37 ± 0.48) mmol/L vs.(4.96 ± 0.52) mmol/L,(1.44 ± 0.29) mmol/L vs.(1.75 ± 0.27) mmol/L,(2.38 ± 0.38) mmol/L vs.(2.90 ± 0.60) mmol/L,(80.37 ± 10.42) mmHg (1 mmHg =0.133 kPa) vs.(89.23 ± 14.76) mmHg,(478.70 ±544.65) yuan vs.(977.85 ±585.35) yuan,(1 681.92 ± 623.62) yuan vs.(1 950.43 ± 563.36) yuan,(14.50 ± 3.55) scores vs.(17.23 ± 4.28) scores,(96.29 ± 15.67) scores vs.(107.90 ± 15.31) scores] (P ＜ 0.01),SBP and HAMA scores were lower than those in control group [(130.66 ± 12.52) mmHg vs.(138.87 ± 16.41) mmHg,(18.55 ± 4.16) scores vs.(21.10 ± 4.33) scores] (P ＜ 0.05),frequency of blood glucose monitoring per month was significantly higher than that in control group [(30.55 ± 16.98) times/month vs.(8.65 ±7.47) times/month] (P ＜0.01).Conclusions In elderly T2DM patients with chronic complications,integrated management with individual treatment strategy can significantly improve metabolic disorders,decrease hospital costs,improve the symptoms of anxiety and depression,and improve quality of life. Key words: Disease management; Diabetes mellitus; Diabetes complications; Quality of life