Effect of shared medical appointments on blood glucose levels and self-management behavior in patients with gestational diabetes mellitus
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摘要:目的
探讨妊娠糖尿病(GDM)患者的共享门诊(SMA)模式对血糖水平和自我管理行为的影响。
方法纳入2021年10月—2022年10月在徐州医科大学附属宿迁医院妇产科、内分泌科门诊诊断为GDM的孕妇87例, 将其分为治疗组44例和对照组43例。治疗组应用SMA模式进行GDM管理，对照组予常规门诊随访。比较2组基线资料、治疗前后扫描式葡萄糖监测(FGM)相关指标以及自我管理行为量表评分。
结果2组患者年龄、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)等指标比较，差异均无统计学意义(P>0.05)。治疗组治疗后葡萄糖目标范围内时间(TIR)高于对照组，平均血糖波动振幅(MAGE)、血糖标准差(SDBG)、血糖变异系数(CV)、平均血糖(MBG)均低于对照组，差异均有统计学意义(P < 0.05)。治疗组治疗后TIR高于治疗前, MAGE、CV、SDBG、MBG低于治疗前，差异均有统计学意义(P < 0.05); 对照组治疗后TIR高于治疗前，治疗后SDBG、MBG低于治疗前，差异均有统计学意义(P < 0.05)。治疗后，治疗组自我管理行为总分、饮食管理、运动管理、药物管理、血糖监测管理评分均高于对照组，差异均有统计学意义(P < 0.05)。治疗组治疗后自我管理行为总分、饮食管理、运动管理、药物管理、血糖监测管理评分均高于治疗前，对照组治疗后自我管理行为总分、药物管理、血糖监测管理评分高于治疗前，差异均有统计学意义(P < 0.05)。
结论SMA管理模式可全面改善患者血糖水平，提升自我管理行为能力。
Abstract:ObjectiveTo investigate the impact of the Shared Medical Appointment (SMA) model on blood glucose levels and self-management behaviors in patients with gestational diabetes mellitus (GDM).
MethodsA total of 87 pregnant women diagnosed with GDM at the Obstetrics and Gynecology and Endocrinology Outpatient Departments of the Affiliated Suqian Hospital of Xuzhou Medical University from October 2021 to October 2022 were enrolled and divided into treatment group (n=44) and control group (n=43). The treatment group received SMA-based GDM management, while the control group underwent routine outpatient follow-up. Baseline data, flash glucose monitoring (FGM)-related indicators before and after treatment, and self-management behavior scale scores were compared between the two groups.
ResultsNo statistically significant differences were observed between the two groups in age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c) (P>0.05). After treatment, the time in range (TIR) of glucose was higher in the treatment group than that in the control group, while mean amplitude of glycemic excursions (MAGE), standard deviation of blood glucose (SDBG), coefficient of variation (CV), and mean blood glucose (MBG) were lower in the treatment group (P < 0.05). Within the treatment group, post-treatment TIR was higher, and MAGE, CV, SDBG, and MBG were lower than pre-treatment levels (P < 0.05). In the control group, post-treatment TIR was higher, and SDBG and MBG were lower than pre-treatment levels (P < 0.05). After treatment, the total score and scores for dietary management, exercise management, medication management, and blood glucose monitoring management in the self-management behavior scale were significantly higher in the treatment group than in the control group (P < 0.05). In the treatment group, post-treatment scores for all self-management behaviors were higher than pre-treatment levels, while post-treatment total scores and scores for medication management and blood glucose monitoring management in the control group were higher than pre-treatment levels (P < 0.05).
ConclusionSMA management model can comprehensively improve blood glucose levels and enhance self-management behavior capabilities in GDM patients.
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表 1 2组患者一般资料比较(x±s)[M(P25, P75)]
指标 治疗组(n=44) 对照组(n=43) t/Z P 年龄/岁 30.02±7.52 29.86±8.17 0.096 0.923 BMI/(kg/m2) 24.05±2.73 23.75±2.78 0.508 0.613 FBG/(mmol/L) 5.43(5.14, 5.86) 5.30(5.01, 5.80) -1.074 0.283 HbA1c/% 6.15(6.00, 6.58) 6.20(5.90, 6.55) -0.512 0.609 TC/(mmol/L) 5.31±0.79 5.27±0.88 0.231 0.818 TG/(mmol/L) 1.51(1.20, 1.84) 1.37(0.96, 2.24) -1.210 0.226 LDL-C/(mmol/L) 2.96±0.71 2.96±0.79 0.043 0.966 HDL-C/(mmol/L) 1.25(1.17, 1.43) 1.26(1.11, 1.41) -0.705 0.481 BUN/(mmol/L) 5.79±1.82 6.37±1.66 1.545 0.126 CR/(mmol/L) 76.62±9.96 74.44±8.48 1.095 0.277 UA/(μmol/L) 315.8±91.64 347.6±98.77 1.558 0.123 SBP/mmHg 135.91±18.97 132.86±18.70 0.755 0.452 DBP/mmHg 82.32±13.72 79.05±12.01 1.183 0.240 BMI: 体质量指数; FBG: 空腹血糖; HbA1c: 糖化血红蛋白; TC: 总胆固醇; TG: 甘油三酯; LDL-C: 低密度脂蛋白胆固醇; HDL-C: 高密度脂蛋白胆固醇; BUN: 尿素氮; CR: 肌酐; UA: 尿酸; SBP: 收缩压; DBP: 舒张压。1 mmHg=0.133 322 kPa。 
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表 2 2组患者治疗前后FGM相关指标比较[M(P25, P75)]
指标 时点 治疗组(n=44) 对照组(n=43) TIR/% 治疗前 69.50(59.25, 83.75) 64.00(48.00, 80.00) 治疗后 91.00(87.25, 99.00)*# 82.00(74.00, 89.00)* MAGE/(mmol/L) 治疗前 6.36(4.77, 8.67) 6.19(4.43, 8.38) 治疗后 2.35(1.38, 3.63)*# 6.06(4.48, 8.77) CV/% 治疗前 18.76(12.86, 25.85) 20.48(14.07, 26.43) 治疗后 11.32(8.2, 15.97)*# 16.83(12.47, 22.01) SDBG/(mmol/L) 治疗前 1.29(0.92, 1.57) 1.23(0.78, 1.66) 治疗后 0.54(0.39, 0.86)*# 0.86(0.61, 1.29)* MBG/(mmol/L) 治疗前 6.93(5.82, 8.43) 6.85(5.54, 7.88) 治疗后 4.83(4.15, 6.04)*# 5.69(4.31, 7.31)* TIR: 葡萄糖目标范围内时间; MAGE: 平均血糖波动振幅; CV: 血糖变异系数; SDBG: 血糖标准差; MBG: 平均血糖。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组患者治疗前后自我管理行为量表评分比较(x±s)
分 指标 时点 治疗组(n=44) 对照组(n=43) 自我管理行为总分 治疗前 33.11±5.75 33.07±6.22 治疗后 45.55±6.00*# 37.49±6.87* 饮食管理评分 治疗前 16.07±6.16 15.95±5.96 治疗后 20.55±5.34*# 16.70±5.87 运动管理评分 治疗前 7.66±2.66 7.77±3.05 治疗后 9.95±2.47*# 7.86±2.65 药物管理评分 治疗前 3.59±1.72 3.53±1.96 治疗后 5.36±1.12*# 4.65±1.19* 血糖监测管理评分 治疗前 5.80±3.09 5.81±2.51 治疗后 9.68±2.28*# 8.28±2.77* 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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