多学科合作的延续护理管理对2型糖尿病2+N逆转治疗患者远期代谢的影响 [中文引用][英文引用]

目的  探讨多学科合作的延续护理管理对 2 型糖尿病 2+N 逆转治疗患者远期代谢的影响，为临床提供一种有效的管理方法。方法  采用回顾性队列研究，选取 2025 年 1 月至 9 月于本中心治疗的 2 型糖尿病患者 90 例，首先接受为期 3 个月的强化期干预—多学科合作的延续护理管理，随后根据患者意愿分为两组（各 45 例），观察组采用巩固期—多学科合作的延续护理管理，对照组采用常规延续护理管理。分别在强化干预前（T1）、强化干预 3 个月（T2）及巩固期延续管理结束时（T3）测量两组患者的糖化血红蛋白、体质指数、腹围、尿酸、血脂四项代谢指标。校正潜在混杂因素后采用混合效应模型分析比较两组患者在不同时间点的代谢指标变化情况。结果  两组患者均完成研究。混合效应模型分析显示，糖化血红蛋白的组间效应具有统计学意义（P<0.001），糖化血红蛋白、体质指数的交互效应具有统计学意义（均 P<0.05），糖化血红蛋白、体质指数、腹围、甘油三酯和高密度脂蛋白胆固醇的时间效应具有统计学意义（均 P<0.001）。3 个时间点组内比较：两组 T2、T3 的糖化血红蛋白、体质指数、腹围、甘油三酯均较 T1 时降低（均 P<0.05），T3 相较于 T2，仅对照组糖化血红蛋白出现反弹（P<0.05），其余指标在两组中均保持稳定（均 P>0.05）；观察组高密度脂蛋白胆固醇在 T2、T3 较 T1 时升高，T3 较 T2 也升高（均 P<0.05）。3 个时间点组间比较：在 T3 时，观察组糖化血红蛋白、体质指数、腹围均低于对照组（P<0.05），其余指标比较，差异无统计学意义（均 P>0.05）。结论  接受 2 型糖尿病 2+N 逆转治疗的多学科合作的延续护理管理后患者主要代谢指标呈现改善趋势，特别是持续“巩固期”多学科合作的延续护理，其核心代谢指标在长期调控中展现出更优的效果。

Objective To evaluate the effect of multidisciplinary continuing-care（MCC）management on long-term metabolic outcomes in patients with diabetes treated with 2+N diabetes reversal therapy and to provide guidance for effective management of the patients. Methods A total of 90 adults with Type II diabetes who were treated between January and September 2025 were enrolled in this interventional study. After a 3-month of intensive MCC，the patients were assigned into two groups（n=45 per group）according their selection：patients in the observation group were treated with MCC until the consolidation phase，while those in the control group received standard continuing care. Glycated haemoglobin（HbA1c），body-mass index（BMI），waist circumference，uric acid and a standard lipid panel were taken and tested at three time points of baseline（T1），end of intensive intervention（T2）and end of consolidation（T3）. A linear mixed-effects model，adjusted for potential confounders，was used to compare metabolic changes across time and between groups. Results All patients completed the study. A significant main effect between-group was observed on HbA1c（P<0.001），and significant group-by-time interactions were found for HbA1c and BMI（both P<0.05）. Significant time effects were detected for HbA1c，BMI，waist circumference，triglycerides and high-density-lipoprotein cholesterol（HDL-C）（all P<0.001）. Within-group analyses showed that，in both groups，HbA1c，BMI，waist circumference and triglycerides were significantly lower at T2 and T3 than at T1（all P<0.05）. While it was noticed that from T2 to T3，HbA1c rebounded significantly in the control group（P<0.05），whereas other indicators remained stable （P>0.05）. HDL-C rose progressively in the observation group（T10.05）. Conclusion Multidisciplinary continuing-care integrated with“+N diabetes reversal therapy improves key metabolic indicators. The continued consolidation-phase multidisciplinary care yields superior long-term control of the core metabolic indicators of diabetes.