The Effectiveness of Diabetes Shared Care Model and Factors Associated with Glycemic Control in Diabetics Patients-a Case of Medical Center

• Main Authors: Cheng-chung Lin, 林正宗
• Other Authors: Hsin-Chia Hung
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/68057214159285663462

碩士 === 國立中山大學 === 醫務管理研究所 === 93 === PURPORSE：This purpose of the study is to investigate the effectiveness of diabetes shared care model (DSCM)and the factors associated with extent of glycemic control. METHOD：We analyzed 212 patients who completed the five shared care visits and 739 patients who completed the second follow-up visit. Patients are recruited from a department of Endocrinology of medical center located in southern part of Taiwan. Data used in this study were collected from the patients’ medical records. To evaluate effectiveness of diabetes shared care model（dietary compliance, exercise behavior compliance, clinical indicators）and to examine the factors associated with the hemoglobulin A1c is the purpose of the study. RESULT： In 212 patients completing the 5 visits, the compliance of carbohydrate consumption was significantly improved, however, there was no significant improvement in those of calories and fat consumption. Further analysis in 739 patients who completed the second follow-up visit, we found that the compliance of calories and fat consumption was significantly improved. The compliance of carbohydrate was improved, but not reaching significant difference. Although the compliance of 212 patients’ exercise behavior was not significantly improved, the compliance of 739 patients’ exercise behavior was significantly improved. The improvement of clinical indicators following participating the DCSM are as followed： 1.The hemoglobulin A1c（before：8.1% vs after：7.9%，P=0.04）、fasting plasma glucose（before：164.1mg/dL vs after：136.8 mg/dL，P<0.01）、total cholesterol （before：200.9mg/dL vs after：187.3 mg/dL，P<0.01）、low density lipoprotein（LDL）（before：121.0mg/dL vs posttest：113.1 mg/dL，P<0.01）、high density lipoprotein（HDL）（before：42.6mg/dL vs posttest：46.2 mg/dL，P<0.01）of 212 patients were significantly improved. On the other hand, the triglyceride（pretest：159.9mg/dL vs after：152.2 mg/dL，P=0.71）、systolic blood pressure（before：132.5mmHg vs after：137.3 mmHg，P=0.34）and diastolic blood pressure（before：79.5 mmHg vs after：78.4 mmHg，P=0.09）of 212 patients were not significantly improved. 2.In 739 patients who only completing the second follow-up visit, the hemoglobulin A1c、fasting plasma glucose、diastolic blood pressure were significantly improved but the systolic blood pressure was remain unchanged. Finally, multivariate regression modeling was used to investigate the factors associated with extent of glycemic control improvement (first visit HbA1c-annual visit HbA1c) in 212 patients competing the annual visit. After adjusting for age and sex, patients’ sex, level of first visit hemoglobulin A1c and level of first visit triglyceride was associated with the extent of glycemic control.