关键词: 糖尿病, 2型, 社区卫生服务, 依从性, 社区管理年限

Abstract: Background　Community-based management can improve the treatment compliance to obtain a better outcome in diabete patients. Available related studies mostly focus on the impact of community-based management on the treatment compliance of diabete patients. But the association of treatment compliance and years of community-based management has rarely been studied. Objective　To explore the treatment compliance and its association with years of community-based management in type 2 diabetes. Methods　From July to September 2017，15 088 type 2 diabetes who had applied for a health card and received community-based management as of September 29，2017 were recruited from Shanghai Putuo Community Health Service Center. Data regarding demographics and disease-related information，treatment and treatment compliance were obtained through the community-based diabetes management system. Logistic regression was used to examine the association between years of community-based management and treatment compliance. Results　The average duration of community-based management was （4.05±2.46） years，with oral hypoglycemic drugs as the major intervention（10 462 patients，69.34%）. Among them，12 156（80.57%） met the target HbA1c level，7 621（50.51%） had satisfied BMI control，9 589（63.55%） had good blood pressure control，but 5 855（38.81%） with central obesity did not meet the target waist circumference. The medication compliance was 95.55%（13 107/13 717）. The medication compliance varied significantly by age，course of type 2 diabetes，treatment，BMI control status and years of community-based management（P<0.05）. The diet control rate was 87.19%（13 155/15 088），which varied significantly according to sex，age，course of type 2 diabetes，treatment，BMI control status and years of community-based management（P<0.05）. The regular exercise rate was 47.45%（7 159/15 088）. The regular exercise rate differed significantly by age，course of type 2 diabetes，and years of community-based management（P<0.05）. After adjusting for sex，age，course of type 2 diabetes，BMI and treatment，Logistic regression analysis found that medium- and long-term（1-4 years） community-based management was a facilitator for regular exercise behavior〔OR=1.415，95%CI（1.225，1.637），P<0.05〕. Long-term（>4 years） community-based management was a facilitator for medication compliance〔OR=2.925，95%CI（2.109，4.022），P<0.05〕，good diet control〔OR=2.051，95%CI（1.689，2.481），P<0.05〕，and regular exercises〔OR=2.596，95%CI（2.239，3.016），P<0.05〕. Conclusion　On the whole，the treatment compliance was good in this group of diabetes，but the prevalence of regular exercises was poor. To further improve their treatment compliance，community-based exercise guidance for these patients should be strengthened. Moreover，it is suggested to give community-based management to diagnosed diabetes as early as possible，and long-term management is a better choice since it is more helpful to cultivate good treatment compliance.

Key words: Diabetes mellitus, type 2；Community health services；Compliance；Years of community-based management