衛生所第二型糖尿病患加入糖尿病共同照護計畫後代謝指標的變化分析

Changes to metabolic indices of patients who have type 2 diabetes and are included in the Diabetes Shared Care Program administered in a public health center in Taiwan

"目標：糖尿病醫療給付改善方案自2001年實施至今，文獻中探討衛生所執行糖尿病共同照護計畫的研究相當少。本研究以中部某衛生所的糖尿病共照計畫個案資料，分析患者加入糖尿病共照計畫後，代謝指標的長期變化。方法：以回溯性世代研究法進行資料收集及分析，擷取台灣某衛生所「糖尿病共同照護服務管理系統」2002年5月至2008年12月加入共照計畫的個案為研究對象，每位個案自初診後追蹤至多8年，平均追蹤6.2年。使用廣義估計方程式，分析患者加入糖尿病共照計畫後各項代謝指標的變化。結果：共133位納入分析。在前二年分析中，糖化血色素以第4季下降幅度最大（β＝-0.41, p＝0.003）；在長期8年的分析中，糖化血色素≥9％的比率，自初收案的28.6％，至第1年底及其後各年度均維持在20％以下。舒張壓在短期有顯著下降；長期而言，血壓控制良好的比率有逐年上升的趨勢。結論：衛生所推動糖尿病共照計畫，使就診病患能獲得良好的照護。加入共照計畫的患者，血糖及血壓的控制整體而言可獲得逐步改善。建議未來能持續招募糖尿病患加入共照計畫，以提升整體照護率及代謝指標之改善。"

Objectives: Taiwan established the Diabetes Shared Care Program (DSCP) in 2001, but few studies have discussed the DSCP's implementation by public health centers (PHCs) in the community. Thus, this study aimed to analyze the changes to the metabolic indices of patients who had type 2 diabetes and joined the DSCP through a PHC in Central Taiwan. Methods: Participants were enrolled retrospectively from a DSCP database of outpatients who had diabetes mellitus and visited a PHC in Central Taiwan at any period between May 2002 and December 2008. After enrollment, the participants were tracked for up to 8 years, with the average follow-up period being 6.2 years. Due to the use of repeated measurements, generalized estimating equations were applied to evaluate the changes to the examined indices over time. Results: The data of 133 patients were analyzed. In the first 2 years of follow-up, HbA1c significantly decreased in the fourth quarter (β= -0.41, p=0.003). For the 8-year long-term follow-up, the percentage of patients with HbA1c≥9% decreased from 28.6% to 20% or lower in the years following DSCP intervention. The patients' diastolic blood pressure significantly decreased in the short term. The percentage of patients with well-controlled blood pressure increased gradually in the long term. Conclusions: The DSCP implemented by PHCs provides a good quality of care, and it can help patients to continually improve their HbA1c and blood pressure. The DSCP should be promoted among patients with diabetes to improve their metabolic indices.