关键词: 2型糖尿病, 大血管病变, 一级预防, 卫生经济学, 前瞻性研究

Abstract: Objective: To explore the changes of incidence of major vascular lesions after intensive intervention of multiple controllable risk factors in the type 2 diabetes mellitus (T2DM) patients in Han population in Northeast China, and to establish an effective, standardized and cost-effective intervention scheme for the primary prevention of major vascular lesions of the T2DM patients.Methods: A total of 300 T2DM patients newly diagnosed or diagnosed in one year without major vascular lesions were randomly divided into conventional treatment group(n=150) and intensive intervention group (n=150). The clinical study method of parallel control was used to intervene in the some controllable risk factors for 2 years to varying degrees.The body mass index (BMI), waist/hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h PBG), glycosylated hemoglobin (HbA1c), serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), high density lipoprotein (HDL-c), intima media thickness (IMT) and incidence of majoy vascular lesions of atherosclerosis(AS) of the patients in two groups were measured,and the medical expenses of the patients were analyzed statistically.Results: After 2-year-follow-up,the DBP, FBG, 2 h PBG, HbA1c, TG, TC and HDL-c of the patients in conventional treatment group were significantly lower than those before treatment (P<0.05).After 2-year-follow-up, the BMI, SBP, FBG, 2 h PBG, HbA1c, TG, TC, HDL-c and LDL-c of the patients in intensive intervention group were significantly lower than those before treatment (P<0.05). After 2-year-follow-up,the BMI, TC and IMT of the patients in intensive intervention group were significantly lower than those in conventional treatment group (P<0.05); compared with before treatment, the IMT of the patients in conventional treatment group after 2-year-follow-up was significantly decreased (P<0.05);compared with intensive intervention group, the IMT of the patients in conventional treatment group after 2-year-follow-up was significantly increased (P<0.05).The incidence of AS of the patients in intensive intervention group was lower than that in conventional treatment group (P<0.05). The medical expenses of the patients in both two groups were increased year by year; the 2-year total medical expenses, per capita annual medical expense in the first year and second year of the patients in intensive treatment group were lower than those in conventional treatment group (P<0.05).Conclusion: Intensive intervention of multivessel risk factors of is an effective way to prevent and treat the major vasular lesions of the T2DM patients.

Key words: type 2 diabetes mellitus, major vascular lesions, primary prevention, medical economics, prospective study