Hoang Xuan Thuc vd dig Tap chi KHOA HOC & CONG NGHE 81(05): 185- 188
KET QUA BlTOfC DAU VIEC THI/C HIEN QUAN LY DAI THAO DU^OTVG TYP 2 TAI TINH BAC GIANG N A M 2010
Hoang Xuan Thuc', Nguyen Van Tu'^
'Sa Y te Bac Giang, 'Trudng DH Y Dugc - DH Thdi Nguyen
TOMTAT
Vdi muc tieu danh gia hieu qua viec kiem soat benh dai thao dudng typ 2 d cdng ddng tai Bac Giang, cac lac gia da su dung phuong phap nghien cuu dich te hgc can thiep de danh gia ket qua kilm soat benh dai thao dudng cho 367 ngudi tai phudng Thg Xuong va xa Song Mai, lhanh phd B5c Giang sau I nam can thiep. Ket qua cho thay BMI> 23 giam xudng - chi sd hieu qua dat 44,3% (p < 0,05). BMI < 23 tang len - chi so hieu qua dat 64,1% (p<0,05). Hieu qua can thiep ddi vdi BMI > 23 dat 71,2% (p<0,05). Ty le nhdm benh dai Ihao dudng giam - chi sd hieu qua dat 43,3%; tiln dai thao dudng giam va khdng cd trudng hgp mac mdi. Ty le glucose > 7 mmol/l d nhdm dai thao dudng giam xudng - chi sd hieu qua dai 73,2% (p < 0,05), hieu qua can thiep dat 186,7% (p<0,05). Ngudi benh dai thao dudng dilu tri mot loai thudc tang len chi sd hieu qua dat 149,6% (p<0,05); dilu In 2 loai thuoc giam xudng - chi sd hieu qua dat 69,3% (p<0,05). Md hinh quan ly dai thao dudng tai Bde Giang budc ddu da cd hieu qua, tuy nhien md hinh quan ly nay mdi triln khai d dien hep, cdn dugc triln khai loan tinh, cd ke hoach chien luge lau dai va dau tu them cac trang thilt bj Ihi hieu qua mang lai se ben vung hon.
Tir khoa: ddl thdo dudng, glucose mdu, BMI, chi sd hieu qud, hiiu qud can thiep DAT VAN DE
Benh dai thao dudng (DTD) la mdt benh rdi loan chuyen hod man tinh phd bien tren the gidi cung nhu d Viet Nam. Benh ddi thao dudng Id nguyen nhdn gay tu vong dung hdng thu nam d cdc nude dang phdt trien; Benh cung dugc xem Id "dai dich" d cdc nude dang phat trien, trong sd benh ddi thdo dudng chu yeu Id dai dudng typ 2, chiem khodng 85-95%
tdng sd ngudi mac benh ddi thdo dudng; sir bdng nd ddi thdo dudng typ 2 va nhung bien chdng cda benh dang Id thach thuc Idn vdi cdngddng[l], [4], [5].
Nhieu cdng trinh nghien cuu tren the gidi da chung minh benh DTD typ 2 va cae bien chung cua nd hodn todn cd the phdng ngua dugc. Viec phdt hien sdm benh vd cdc yeu td nguy CO gay benh cd gia trj rat lon trong cdng tac phdng benh giam ty le mdc benh DTD, Iam gidm hoac cham cdc bien chung, di chdng ddn den ban che dung thudc dieu trj, nang cao chat lugng cudc sdng cua ngudi benh, ldm gidm chi phi cua xa hdi, ddng thdi gidp cho cdng tdc qudn ly vd chdm sdc benh
" Tel: 0979281788
nhan ddi thdo dudng cd hieu qud. Hien nay, sd ngud'i mac DTD tai tinh Bde Giang cd ddu hieu ngdy cdng gia tdng, nam 2002 la 400 ngud'i, den nay sd benh nhan da tdng Ien gdp 5 Idn. Viec phat hien sdm benh DTD typ 2 lai cdng ddng, cung nhu viec lu van, qudn ly dieu Iri benh Id rat cdn thiet. Vi vdy chung tdi lien hdnh nghien cuu de tdi ndy vdi muc lieu:
Budc ddu ddnh gid hieu qud viec kiem sodt binh ddi thdo dudng typ 2 a cdng ddng tgi Bac Giang.
DOI TUONG v A PHUONG P H A P NGHIEN CU'U
Doi tugng nghien cuu
- Ngud'i trudng thanh tu 30 den 69 tudi dang sinh sdng tai Bac Giang, gdm cd nam vd nu.
Loai khdi nghien cuu neu cd mdt trong cac yeu td sau: Ngudi benh dai thdo dudng lyp 1, ddi thdo dudng thai ky, cdc benh ndi liel kem lbeo (Basedow, hdi chdng Gushing, suy gidp, suy gan, suy than...), benh nhdn dang cd hdi chung nhiem toan ceton, cdc nhiem trung cap tinh, dang su dung thudc Costicoid, chen p giao cdm.
- Ddi tugng khdng dung dd tudi
185
Hoang Xuan Thuc vd dtg Tap chi KHOA HOC & CONG NGHE 81(05): 185 Thdi gian va dja diem nghien cuu
- Thdi gian tir thang 1/2010 din thang 12/2010.
- Dja dilm: tai phudng Thg Xuong, xa Song Mai - TP Bde Giang (noi can thiep), thj tran Chu va xa Tan Son huyen Luc Ngan (noi khdng can thiep).
Phuong phap nghien cuu
5M- dung phuang phdp dich te hpc can thiep.
Chgn mdu nghien cu'u:_Tu' co mau md ta cat ngang, sau khi chgn mdu chum nhilu bae de phat hien ty le benh va mdt so yeu td lien quan. Chung tdi chgn chu dich phudng Thg Xuong vd xa Song Mai cua Thdnh phd Bac Giang de can thiep, tdng so doi tugng nghien cuu la 367 ngudi trong dd 21 ngudi mac berih DTD va 66 ngudi tiln ddi thdo dudng (Tiln DTD). Chgn Thi trdn Chu vd xa Tdn Son huyen Luc Ngan Id dia diem khdng can thiep gom 349 ngudi, trong dd cd 11 DTD vd 57 tiln DTD.
Cac chi so nghien cuu
- Cdc chi sd nhdn trac: chieu cao, can nang, BMI.
- Xet nghiem glucose mau luc ddi - Su dung thudc dieu tri DTD Ky thuat thu thap so lieu
Thu thdp thdng tin theo phieu in san. Cdc dieu tra vien dugc lap huan ky ve phuong phdp dieu tra.
Phuang phdp ddnh gid
+ Tieu chudn xdc dinh the trang dua vdo BMI (kg/m') [3].
The trang gay: BMI < 18,5; The trang trung binh: 18,5 <BM1<23; Thua cdn, beo phi; BMI
>23 - 24,9;
+ Chdn dodn DTD, phdn logi DTD vd tien DTD (rdi logn dung ngp glucose) theo WHO ndm 1998 f2f
- Ddi thdo duang: Khi dudng huyet tTnh mach luc ddi >7,0mmol/l hoac dudng huyet tTnh mach > 11,1 mmol/I sau 2 gid Iam nghiem phdp tdng dudng huyet.
Bang 1. Hieu qua can
- Tien DTD (r6\ loan dudng huyet ddi (IFG) hoac roi loan dung nap glucose) La tinh trang dudng huyet cao nhung chua cao den muc bj mdc DTD.
+ Theo tieu chudn kiim sodt dudng mdu Chau A - Thai Binh Duong nam 2002; [2]
Chi sd Glucose huyet
tuong luc ddi
Danh gia kiem soat dudng huyet Tdi uu Kha Kem 4,4-6,1 <7,0 >7,0
+ Ddnh gid hiiu qud
- Chi so hieu qua (CSHQ) %=(pl-p2)/plxl00 Trong dd pl la ty le trudc can thiep, p2 la ty le sau can thiep.
- Hieu qua can thiep (HQCT) %=CSHQ can thiep-CSHQ ehung.
Xix ly so lieu:
Theo phuong phdp thdng ke y hgc.
KET QUA NGHIEN CUU VA B A N LUAN Budc dau ddnh gid hieu qua viec kiem soat benh ddi thdo dudng typ 2 d cdng dong tai Bde Giang, dugc trinh bay d ede bdng 1-4.
Ket qua tai bang 1 cho thay; Sau 9 thdng quan ly cd su thay ddi rd chi sd hieu qud vd hieu qua can thiep vl chi so BMI. Noi qudn ly chi so BMI > 23 giam hon so vdi noi chua dugc qudn ly - hieu qua can thiep dat 71,2%
(p<0,05). Dong thai d noi quan ly chi sd BMI
< 23 cung duge tang hem so vui nai chua dugc qudn ly chi sd hieu qua dat 64,1%
(p<0,05). Nhilu edng trinh nghien cdu cho thay viec giao due che do an udng vd boat ddng the luc nham giam can d nhung benh nhan ddi thdo dudng la het sue can thiet [1], [2],[3]. Sau khi dugc tap huan, truyen thdng cdc ddi tugng da nhan thuc dugc nguyen nhan gay benh va each phdng chdng benh dai thdo dudng. Hg ddnh thdi gian de tang cudng boat ddng the lue, tang cudng luyen tap vd thay ddi ehl do khau phan an hang ngdy theo hudng tich cue. Dieu dd dugc the hien thdng qua chi sd BMI eua dpi tugng tai dja ban qudn ly da cho ket qua tdt.
thiep ve chi sd BMI
BMI BMI > 23 BMK 23
Dia diem Noi quan ly n = 367
SL % 65 17,7 302 80,9
Noi chua quan ly n=349
SL % 106 30,3 243 69,6
Chenh lech
% 12,6 11,3
HQCT %
71,2 13,9
P
<0,05
<0,05
186
Hoang Xuan Thuc vd dig Tap chi KHOA HOC & CONG NGHE 81(05): 185- Hieu qua can thiep benh dai thdo dudng dugc
the hien tren bang 2 va 3:
Sau 9 thdng qudn ly cd su thay ddi rd chi sd hieu qua va hieu qua can thiep ve chi sd glucose huyet tuong > 7,0 mmol/l giam di mdt each rd ret - HQCT dat 186,7% (p<0,05).
Day cung Id minh ehung cho su thdnh cdng khdi ddu cua cdng tdc truyen thdng, tu van, quan ly ddi thdo dudng tai edng ddng.
Sau mdt thdi gian duge qudn ly, tu van va dieu trj ty le mac benh dai thao dudng vd tien dai thao dudng da thap hon so vdi noi chua dugc quan ly, chi sd hieu qud ve ty le mac benh ddi thdo dudng 43,3% (p< 0,05). Ty le lien ddi thdo dudng thap hon 13,8% so vdi 17,8% - CSHQ dat 70,3% (p>0,05). Ddng luu y la khdng cd trudng hgp mac ddi thdo dudng
vd tien ddi thdo dudng mdi. Nhu vdy cdng tdc truyen thdng ve benh ddi thdo dudng tai cdng ddng da dem lai hieu qua mdt cdch rd ret.
Ngudi benh ddi thdo dudng su dung mgl loai thudc dugc tdng Ien tu 28,6% Ien 71,4% sau 9 thdng dieu tri - Chi sd hieu qud dat 149,6%
(p<0,05). Ty le ngudi dugc dieu trj 2 loai thudc gidm tu 52,3% xuong cdn 19% - CSHQ dat 69,3% (p<0,05). Khdng cd trudng hgp ndo dung Insulin don ddc. Rieng 2 trudng hgp dieu trj phdi hgp giua Insulin va Sulfonylurea sau 9 thdng khdng thay ddi, 2 trudng hgp nay kiem sodt dudng huyet cd xu hudng xau di do benh nhdn phdt hien vd dieu trj mudn, thdi gian mac lau ndm, dieu trj nhieu noi, khdng duy tri thudc, khdng luyen lap thudng xuyen vd khdng thay ddi thdi quen dn udng.
^~~^-..._^^Dja diem
Glucose ^~~~~~-^
Bang 2. Hieu qua can thiep ve chi sd glucose mau
Noi quan ly Noi chua quan ly Chenh n = 367 n = 349 lech .^ SL % SL % %
HQ CT
%
P Binh thudng
Glucose <5,6 Tiln DTD
5,6 < Glucose < 7,0 DTD Glucose > 7,0
305
56 6
83, 272 77,9 7,3 <0,05
15,3 1,6
62 15
17,8 4,3
3,9 2,7
70,3 186,7
<0,05
<0,05
^"'-^-^.^ Dja diem
DTD "^----...^
DTD Tiln DTD Mac mdi
^~-~--.-_.,^^ Thdi diem Dung thudc ^~~~~----...^
Dung 1 loai thudc:
- Sulfonylurea - Metformin Dung 2 loai thudc:
- Sulfonylurea - Metformin Insulin don ddc Insulin+Sulfonylurea hoac thudc khac
Bang 3.
Noi quan n = 367 SL
6 51
0
Bang 4.
Trudc (n^
SL 6 4 2 13 13 0 2
Hiei ly
%
1 qua can thi
1,6 13,8 0 Che do sd can thiep
= 367)
% 28,6
19,0 9,5 61,9 61,9 0 9,5
ep benh dai thao Noi chua quan ly
n=349 SL
15 62 4 dung
% 4,3 17,8
1,1 thudc ha dudng
Sau can thiep (n=367)' SL
15 6 9 4 4 0 2
% 71,4 28,6 42,9 19,0 19,0 0 9,5
dudng Chenh lech
% 2,7 3,9 1,1 huyet
Chenh lech
% 42,8
9,6 -33,4 -42,9 -42,9 0
HQCT
% 43,3 70,3
CSHQ
% 149,6
69,3 0 0
P
<0,05
>0,05
P
<0,05
<0,05
>0,05
187
Hoang Xuan Thuc vd dtg Tap chi KHOA HOC & CONG NGHE 81(05): 185 KET LUAN
Nghien cuu viee kiem soat benh ddi thao dudng cho 367 ngudi tai phudng Thg Xuong vd xa Song Mai, thanh phd Bac Giang, ket qud cho thdy;
- Chi sd BM1> 23 giam xudng - chi sd hieu qua dat 44,3% (p < 0,05). Chi so BMI < 23 tang Ien - chi sd hieu qud dat 64,1 % (p<0,05).
Hieu qud can thiep ddi vdi chi sd BMI > 23 dat 71,2% (p<0,05).
- Ty le nhdm benh ddi thdo dudng giam - chi sd hieu qud dat 43,3%; ly le nhdm tien dai thdo dudng gidm vd khdng cd trudng hgp mac benh ddi thao dudng vd tien ddi thdo dudng mdi.
- Ty le glucose > 7 mmol/l d nhdm ddi thdo dudng gidm xudng - cbi sd hieu qua dat 73,2% (p < 0,05). Hieu qud can thiep dat
186,7% (p<0,05).
- Ngudi benh ddi thdo dudng dieu trj mdt loai thudc tang len chi sd hieu qua dat 149,6%o (p<0,05); dieu trj 2 loai thudc gidm xudng - chi so hieu qud dat 69,3% (p<0,05).
KHUYEN NGHI
I. De phdng chdng benh DTD ngay cdng cd hieu qua de nghj cdn xdy dung mgl md hinh qudn ly benh DTD tren dja ban loan tinh thdng nhdt, mang chien luge Idu ddi: nen thanh lap mdi trung tdm y te du phdng (hoac trung tdm y te) tuyen huyen mdt phdng tu
van, de phdi hgp vdi Lang sire khde van hda d dja phuong cung vdi cac doan the thuc hien tu van, truyen thdng phdng chdng benh dai thdo dudng tren dja ban.
2. Bd Y t l , UBND tinh va Sd Y te edn dau tu ve kinh phi, trang thiet bj, thudc men de cdng tdc quan ly benh dai thao dudng ngdy cdng hieu qua hon.
TAI LIEU THAM K H A O
[l].Ta Van Binh (2005), Anh hutmg cua thoi quen dn udng vd tinh trgng hogt ddng thi lire din rdi logn chuyin hoa dudng, Ky yeu toan van cdng trinh nghien cdu khoa hgc ngi tiet va chuyen hoa.
Nhd xuat ban y hgc Tr 788 - 789.
[2].Ta Van Binh (2006), Dich ti hgc binh DTD a Viet Nam. Cdc phuong phdp diiu tri vd bien phdp du phong, Nha xuat ban Y hgc.
[3].Ta Van Binh (2007), NhOng nguyen ly nin tdng binh DTD tdng glucose mdu, Nhd xudl ban Y hgc.
[4]. Nguyin Vinh Quang (2005), Tmh hinh mdc binh ddi thdo dudng a ngudi 30 - 65 tudi tgl khu vuc thdnh thi cita 2 dnh ddng bdng Bac Bg, Ky yeu loan van cdng Irinh nghien cuu khoa hgc ndi liet va chuyen hoa. Nha xuat ban Y hgc Tr 598 - 601.
[5].Truong Van Sdu (2007), Nghien ciru dgc diim ldm sdng, can ldm sdng vd mat sd yiu liin quan trin benh nhdn ddl thdo dudng typ 2 tgi binh viin da khoa tinh Bac Giang, Ludn van Thac sy Y khoa, Dai hgc Y khoa Thai Nguyen.
S U M M A R Y
INITIAL R E S U L T S O F M A N A G E M E N T D I A B E T E S T Y P 2 IN B A C G I A N G P R O V I N E IN 2010
Hoang Xuan Thuc', Nguyen Van Tu'*
Bac Clang Provincial Health Department 'College of Medicine and Pharmacy- TNU In order to evaluate effectiveness of controlling typ 2-diabetes at communities in Bac Giang province, the authors applied epidemic studying method with inten'ention to evaluate results of diabetic management for 367 patients at Tho Xuong Ward and Song Mai commune in Bac Giang city. Alter one year with intervention, the results coming up as followings: BMI> 23 is reduced- effeciency indicator achieves 44,3% (p < 0,05). BMI < 23 is increased - effeciency indicator is 64.1% (p<0.05). The efficiency of intervention for BMI > 23 accounts for 71,2% (p<0.05). Proportion of patients with diabetes go down - efficiency indicator gains 43,3%: Proportion of patients in pre-diabetes are declined and there is no new patient Percentage of diabetes patients with glucose > 7 mmol/l are diminished - efficiency indicator is 73.2% (p < 0.05), efficiency of intervention takes up 186.7%
(p<0,05). There is an increase in number of diabetes patients who have to take only one kind of drug for treatment- efficiency indicator makes up 149.6% (p<0.05): while there is decline in those who have to take 2 kinds of drags - the achieved efficiency indicator is 69.3% (p<0.05). The management module in Bac Giang achieved initial outcomes. However, it has just been a small scale program. It should be implemented in provincial wide with long term strategic plan and more investment for equipment, which will lead to more sustainable achievements.
Keywords: diabetes, glycemia, BMI, effeciency indicators, efficiency ofintei-ventlon
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