Effect of community management of diabetic patients with hypertension

Objective To evaluate the effect of community management of diabetic patients with hypertension in Beijing Cuigezhuang community in last three years. Methods A community diabetic management program was started from 2007 in Beijing Cuigezhuang community. Three hundred and seventy six patients who participated in the program for more than 3 years were enrolled in the study, including 196 with type 2 diabetes mellitus (T2DM) only (DM group) and 180 with T2DM and hypertension (DMH). The control rate of blood glucose, blood pressure, lipids and the comprehensive control rate were compared between two groups after 3-year intervention. Results There were no significant differences in age, gender ratio, course of diabetes, education background, monthly income and the history of stoke between two groups; while prevalence of dyslipidemia in DMH group was significantly higher than that in DM group [41.7%(75/180) vs. 24.5%(48 196), χ2=11.938, P=0.001]. Compared with the baseline data, the types of antidiabetic drugs used were not significantly changed in two groups after 3-year intervention (DM group: 1.32±0.81 vs.1.31±0.93, t=-0.155, P=0.877, DMH group: 1.43±0.72 vs. 1.48±0.82, t=0, 831, P=0.407). The types of antihypertensive drug in DMH group were significantly decrease. (1.12±0.77 vs. 1.25±0.45, t=2.484, P=0.014), while the rate of statins usage in DM group was significantly increased [13.3%(26/196) vs. 5.1%(10/196), χ2=7.830, P=0.005]. The hemoglobin A1c (HbA1c) levels in DM group was decreased [(7.4±1.5)% vs. (7.8± 2.1)%, t=2.586, P=0.011]. The systolic pressure [(129±12) mmHg (1 mmHg=0.133 kPa) vs. (133±16) mmHg, t=3.503, P=0.001] and the diastolic pressure [(80±8) mmHg ratio (82±10) mmHg, t=2.436, P=0.016] in DMH group were significantly declined. The average LDL-C level [DM group: (3.0±0.9) mmol/L vs. (3.2±1.0) mmol/L, t=2.165, P=0.032; DMH group (2.9±1.0) mmol/L vs. (3.2±1.1) mmol/L, t=3.210, P=0.002] were also significantly decrease. Compared with the baseline, the comprehensive control rates of blood glucose, blood pressure and lipid level were increased in both groups [DM group: 9.7% (19/196) vs. 6.1%(12/196), χ2=1.716, P=0.190, DMH group 13.9% (25/180) vs. 5.0%(9/180), χ2=8.315, P=0.004]. Conclusions The community management program is effective for improvement of comprehensive control rates of blood glucose, blood pressure and blood lipids in diabetic patients with hypertension in Beijing Cuigezhuang community. Key words: Community health services; Diabetes mellitus, type 2; Hypertension; Disease management