Abstract: Background　The number of diabetes patients in China ranks first all over the world，and most of them are type 2 diabetes mellitus（T2DM）．Diabetes and its complications cause huge economic burdens on the patient，families，and the society.Recently，it has been found that most of T2DM complications could be prevented or delayed if there is adequate universal medical coverage.Objective　To investigate the effects of payment methods by medical insurance supported by different policies on self-management behavioral outcomes in T2DM patients.Methods　A total of 152 T2DM patients participated in the study，including 70 from a tertiary grade A hospital or a community hospital in Guangzhou，and 82 from the Diabetes Center or Inpatient Department，Kiang Wu Hospital in Macau during April 2017 to January 2018.All of them received 12-week self-monitoring of blood glucose with the same guidance and equipments（blood glucose meter，diabetes test strips，blood collection needle，and consumptions related to lab blood tests）provided by our research group.Comparisons of treatment payment methods，self-monitoring of blood glucose compliance，and glycated hemoglobin（HbA1c）were conducted between the two groups.Results　There was a significant difference in the treatment payment method between the two groups of patients during the study（P<0.05）．During the 12-week postdischarge intervention，the blood glucose records of patients from Guangzhou were significantly better than those of patients from Macau（P<0.001）．The treatment payment method was one of the influencing factors for the total frequencies of blood glucose measurements within the intervention period（P<0.05）．There were no significant differences in pre- and post-intervention HbA1c levels between the two groups（P>0.05）．Changes in HbA1c were positively correlated with the frequency of self-monitoring of blood glucose（rs=0.182，P<0.05）．Conclusion　Payment methods by medical insurance supported by different policies exert different effects on self-management behavioral outcomes in T2DM patients.Providing adequate self-monitoring of blood glucose consumables can improve the self-monitoring of blood glucose compliance.Self-monitoring blood glucose intervention can help T2DM patients control their blood glucose better.

Key words: Medicare payment method；Diabetes mellitus, type 2；Blood glucose self-monitoring；Compliance；Guangzhou；Macau

摘要： 背景　我国糖尿病患者数量位居全球首位，患病类型以2型糖尿病（T2DM）为主。糖尿病及其并发症给个人、家庭及社会造成巨大经济损失。近年来发现如果有足够的医疗保障覆盖，绝大部分T2DM并发症及合并症可以被预防或延后。目的　调查不同医疗政策背景下医保支付方式对2型糖尿病患者血糖行为结局的影响。方法　选取 2017年4月—2018年1月在广州市某三级甲等医院或社区医院住院的T2DM患者70例、澳门镜湖医院糖尿病中心或住院部住院的T2DM患者82例为研究对象。由课题组统一提供血糖仪、试纸、采血针、血液检查等用品，指导患者进行为期12周的自我血糖监测，比较两地T2DM患者就诊付费方式、血糖监测依从性、糖化血红蛋白（HbA1c）水平等。结果　试验期间两地患者就诊付费方式差异有统计学意义（P<0.05）。在出院12周的干预过程中，广州地区同期血糖记录情况明显优于澳门地区（P<0.001）。就诊付费方式是出院12周自测血糖总次数的影响因素（P<0.05）。出院12周两地患者HbA1c水平比较，差异无统计学意义（P>0.05）。HbA1c改变量与血糖监测次数呈正相关（rs=0.182，P<0.05）。结论　不同医疗政策背景下医保支付方式对T2DM患者血糖行为结局的影响不同，适当提供自测血糖耗材可提高T2DM患者自我监测血糖的依从性，自测血糖干预可以帮助T2DM患者更好地控制血糖。

关键词: 医保支付方式；糖尿病, 2型；血糖自我监测；依从性；广州；澳门