不同醫師專科別糖尿病照護指引達成度之回溯性分析探討

Retrospective Analysis on the Achievement of the Diabetes Care Guideline of Different Physician Specialties

糖尿病治療的觀念與技術與時俱進，我們設計一回溯性研究，分析新陳代謝科（專科）醫師與非新陳代謝科（一般科）醫師對台灣最新之本土化糖尿病治療指引「2006第2型糖尿病照護指引」建議項目的達成度。本研究於北台灣一區域教學醫院進行，資料來源為電腦資料庫。研究對象為2007年間在個案醫院門診規律接受糖尿病藥物治療的病患，排除曾於個案醫院急診就醫或住院治療的病患，也排除於專科門診與一般科門診皆治療過糖尿病的病患。研究區間為2007年1月至2007年12月。專科組病患及一般科組病患分別為653人及662人。在過程面指標方面，專科組的血糖、糖化血色素、完整血脂肪、腎功能、肝功能、尿液檢查或微量蛋白尿、及眼底檢查與視力檢查等項目的定期檢查率皆顯著優於一般科組，一般科組的心電圖定期檢查率則顯著高於專科組。在結果面的指標方面，本研究的病患只有12.1%達到理想血糖控制，兩組的比率無差異；達到血脂肪治療目標的病患只有4.0%，專科組的比率顯著高於一般科組。本研究為台灣首次針對「2006第2型糖尿病照護指引」達成度的報告，我們建議加強對糖尿病治療觀念及治療指引內容的教育。

The treatment of diabetes mellitus has been advanced. We designed a retrospective study to analyze the achievement of the most recently local treatment guideline, “2006 Treatment Guideline for Type 2 Diabetes Mellitus”, for endocrinologists and generalists. The study was conducted with the computer database in a regional teaching hospital in Northern Taiwan. Patients receiving medical treatment for diabetes in the outpatient clinics in 2007 were included, and those who visited the emergency department or were admitted in the hospital and those who were treated by both endocrinologists and generalists in 2007 were excluded. The database in 2007 was analyzed. There were 653 patients in the endocrinologist group and 662 patients in the generalist group. The measurement outcome for the regularity of measuring the blood glucose, hemoglobin A1c, lipid, renal function, liver function, urinalysis or microalbuminuria, and examination of eye fundus and visual acuity was significantly different and better in the endocrinologist group. The regularity of performing the electrocardiogram was significantly different and better in the generalist group. Only 12.1% of patients obtained optimal glycemic control, with no difference between the two groups. Only 4.0% of patients obtained optimal lipid control, and the achievement rate was better in the endocrinologist group. Our study is the first report about the achievement of “2006 Treatment Guideline for Type 2 Diabetes Mellitus”. We suggest to enhance education about the diabetes treatment and the treatment guideline content for health care professionals.