Objective:To explore the dynamic effects of 5 years outcome rate of patients with type 2 diabetes who was joint managed by jinsong community and tongren hospital.Method:441 patients with type 2 diabetes in Jinsong community were randomly divided into to the intensive group(n=220)and the standard group(n=221)ran-domly.They were managed by unified model respectively for five years.The changes in the indicators and the joint standard-achieving rate were compared before and after 5 years'treatment.Results:There were no significant differ-ences in compliance rates between the two groups before comprehensive management (P >0.05).After comprehen-sive management,the joint standard-achieving rate in the intensive group control increased from 2.73% to 40.91%, which was significantly higher than that in the standard group(32.13%).The control rates of fasting plasma glu-cose,glycolated hemoglobin and blood pressure in the intensive group were increased from 54.09% to 72.27%,40. 00% to 70.90% and 68.18% to 86.81%,respectively which were significanlly higher than that of standard group(P <0.01 ).The differences were statistically significant.Conclusion:The joint management mode of community hospitals and 3 A hospitals could improve the standard-achieving the patients with type 2 diabetes.%目的：：分析北京劲松社区医院与北京三甲医院联合管理社区2型糖尿病(T2DM)患者的5年达标动态效果。方法：劲松社区441例 T2DM 患者随机分为强化管理组(强化组,n =220)和标准管理组(标准组,n =221)；分别采用不同连续联合管理5年,比较两组管理前后各相关指标和联合达标率,以及不同年份两组各指标达标率变化。结果：管理前两组间除舒张压(DBP)外,其它各指标既空腹血糖(FPG)、糖化血红蛋白(HbA1c)、收缩压(SBP)和低密度脂蛋白胆固醇(LDL-C))达标率比较均无统计学意义(P >0.05),联合管理后,两组组间各项指标达标率和联合达标率均明显高于管理前(P <0.01),强化组5年联合达标率(40.91%)显著高于标准组(32.13%)(P<0.05)；强化组 FPG、HbA1c、血压达标率分别为从54.09%到72.27%、40.00%到70.09%、68.18%到86.81%,也显著高于标准组(P <0.01)。结论：社区医院与三甲医院联合管理模式可有效提高 T2DM 患者达标率。
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