Study On The Comprehensive Management Of Patients With Diabetes In Shanghai Taopu Community

Objectives: This study aimed to assess whether an integrated hospitalcommunity diabetes management program could improve blood glucose,blood pressure and blood lipid control among patients with diabetes and to explore the effect of management of blood glucose,blood pressure and blood lipid on the occurrence of cardiovascular disease(CVD)and prognosis of microvascular complications.Methods: From May 2008 to December 2015,Shanghai Taopu community health service center enrolled 985 diabetic patients.Follow-up investigation on CVD history was conducted from August 2017 to September.2013 Chinese diabetes society(CDS)Standards of Medical Care in Diabetes and 2017 American Diabetes Association Standards of Medical Care in Diabetes were used to evaluate the control of metabolic indices.The CVD event included non-fatal coronary heart disease(CHD),non-fatal stroke and CVD death.Diabetic retinopathy was divided into 5 stages according to the International Clinical Diabetic Retinopathy Disease Severity Scales(2002).According to the Expert Consensus on Prevention and Control of Diabetic Nephropathy(2014),albuminuria was divided into normal,micro and macro albuminuria.Results:(1)After a mean follow-up of 6.7 years,the mean values of haemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure and triglyceride decreased by 0.6%,5.7mmHg,1.5mmHg and 0.32mmol/L,high density lipoprotein cholesterol(HDL-C)increased by 0.05mmol/L.According to 2013 CDS Standards of Medical Care in Diabetes,the attaining rates of HbA1 c,blood pressure,HDL-C and triglyceride were improved by 7%,25.3%,8.4% and 9.3% in diabetic patients.(2)After a mean follow-up of 7 years,the incidence of CVD,stroke and CHD(/1000 personyear)were 40.3,29.1 and 11.9,respectively.Each 1 unit increment of HbA1c(%),each 10 mmHg increment of SBP and each 1 mmol/L increment of triglyceride during follow-up significantly increased risk of CVD by 17%,37% and 14%.Patients attaining none of the three goals(blood glucose,blood pressure and blood lipid)had a 4.3-fold CVD risk than those reaching all the three goals.(3)After a mean follow-up of 5.1 years,15.6% of patients had a reversal of albuminuria,14.1% of them improved from microalbuminuria to normal albuminuria;16.6% of patients had worsened albuminuria,12% of them developed microalbuminuria.(4)After a mean follow-up of 3.8 years,19.4% of patients had a reversal of diabetic retinopathy,13.6% of them improved from mild nonproliferative diabetic retinopathy to no apparent retinopathy;11.1% of patients had worsened diabetic retinopathy.Conclusions: The attaining rates of HbA1 c,blood pressure,HDL-C and triglyceride were significantly improved in diabetic patients.Treatment targeting multiple factors can significantly reduce CVD risk.About 1/5 and 1/6 of patients had improvement of diabetic retinopathy and albuminuria,respectively.