Initial Research Of The Clinical Pathway Management And Analysis Of The Treatment Cost Effectiveness Of Type 2 Diabetes

Objective:To investigate the control rate of blood glucose, lipids, blood pressure and the medical cost of the diabetic patients after two years'clinical pathway management, and observe the influence of follow-up times and literacy on the metabolic control.Methods:A retrospective study was performed observing 246 cases of diabetic patients selected form the diabetes management database, who had been followed up for more than two years. Retrieving blood glucose, lipids, blood pressure data before and after the treatment from the database. These patients were divided into two groups by follow-up times:group A(follow-up times(?)15) and group B(follow-up time>15), observe the change of the blood glucose, lipids, blood pressure after two years' follow-up. At the same time, patients were divided into four groups:elementary school literacy, junior high school literacy, senior school literacy, college literacy, observe the change of the blood glucose, lipids, blood pressure of the four groups after two years' follow up. And 173 patients were strictly followed up. So we calculate the drug expenditure and the examination cost per year of these patients.Results:There are 110 cases (44.72%) that has reached the blood glucose control (HbA1c≤6.5%), while for the blood pressure control goal(BP(?)130/80mmHg) 34 cases (30.36%) in the group of the diabetes patients with hypertension, and the lipid control (LDL-C(?) 100mg/dl)are 78 cases(49.37%) in the group of the diabetes patients with hyperlipidemia. The all controlled cases are 28 (25.00%).The fasting plasma glucose(FPG), postprandial blood glucose(PBG), glycosolated hemoglobin A1c(HbA1c), high-density lipoprotein (HDL-C) levels got improved after two years' follow up, having statistically significant difference (P＜0.05). The FPG,2hPBG,HbAlc,TC,HDL-C levels of group A,and the BMI,FPG,2hPBG,HbA1c,TC,TG,HDL-C levels of group B got improved after two years' follow up, having statistically significant difference (P<0.05). The metabolic control rate of group A and B had no statistically significant difference (P>0.05). The lipid control of the whole patients and group B got improved after two years'follow up, having statistically significant difference (P<0.05). Patients were divided into four groups according to the literacy:As the literacy increased, the FPG,PBG,HbA1c,LDL,HDL of these patients had a decreasing trend when they first got into the database, and the FPG,PBG,HbA1c,LDL,HDL of these patients didn't show a decreasing trend after two years' follow-up. The blood pressure of these patients before or after two years' follow-up didn't show an increasing or decreasing trend. As the literacy of patients increased, the metabolic control rate has an increasing trend when they selected to our database for the first time. The the blood glucose control rate and the lipid control rate got improved after two years'follow-up, but the blood pressure control rate get decreased. The FPG, PBG,HbAlc of these patients with elementary literacy, the PBS,HbA1c,HDL of these patients with junior high school literacy, the FPG,PBG,HDL of these patients with senior high school, and the FPG,PBG,HbA1c,HDL of these patients with college literacy after two years'follow-up got improved, having statistically significant difference (P<0.05); And the lipid control rate of these patients with junior high school literacy got improved, having statistically significant difference (P<0.05); other groups didn't show any improvement after two years'follow up. Medical cost were calculated of 173 patients who were strictly followed up. The average cost of the regular screening is 1549.0 Yuan a year for a single patient, while the total medical expenditure is 5555.8 Yuan, including 4295.5 Yuan for diabetes,1596.8 Yuan for hypertension, and 1244.4 Yuan for hyperlipidemia.Conclusion:The metabolic control could be improved in patients with type 2 diabetes mellitus under the strict management of clinical pathway, especially on these patients with low literacy. But the control rate of blood glucose, lipids and blood pressure of diabetes patients is still not satisfying. The current medical expenditure is expensive for controlling the metabolic disorders. This study aims at lowering the incidence of long-term complications by controlling the blood glucose, lipids, blood pressure. And the saving in medical expenditure of complications can result in improving the efficiency.