Objective To evaluate the long-term cost-effectiveness ratio of intensive glycaemic control versus conventional glycaemic control in patients with type 2 diabetes mellitus(T2DM) in China. Methods A published and validated computer simulation model of diabetes(CORE Diabetes Model) was used to predict long-term(30 years) of health and economic outcomes.Simulated cohorts and treatment effects were derived from 300 diabetic patients in community medical center who were divided randomly into intensive glycaemic control group(n=145) and conventional glycaemic control group(n=155) for 54 months.Results Compared with conventional glycaemic control,intensive glycaemic control showed the reduced cumulative incidences of eye disease,renal disease,foot ulcer and cardiovascular disease(all P 0.05).Background retinopathy,end-stage renal disease,foot ulcer,congestive heart failure, myocardial infarction events were reduced by 4.299%,0.814%,2.357%,2.594%and 4.003%, respectively.Therapy of intensive glycaemic control improved life expectancy significantly(0.476±0.251 years) and associated with improvements by 0.418±0.173 quality-adjusted life years(QALYs),but increased direct medical costs by Chinese Yuan(CNY) 5,940 per patient as compared to coventional glycaemic control.However,the incremental cost-effectiveness ratio was calculated as CNY 14,217 per QALY gained.Conclusion The intensive glycaemic control reduces the cumulative incidences of diabetes complications and improves long term health outcomes for patients with T2DM.Intensive glycaemic control in T2DM patients in China is associated with improvements in life expectancy and QALYs.

Objective To evaluate the effects of an intensified community-based management and treatment on abnormal levels of glucose,blood pressure and lipids in 300 diabetic patients. MethodsThe study included an intensified management group (n=145) and conventional treatment group (n=155). The intensified group was treated with strengthened comprehensive intervention, self blood glucose monitoring, and regular visit at least once a month, while the conventional group was treated as usually in the community medical center for 54 months. The blood glucose and lipids and blood pressure as well as medical cost in two groups were evaluated after 18 months′, 36 months′ and 54 months′ treatment. Results After 18 months′ treatment, the target arrival rates of HbA1c, TC and LDL-C in the intensified group (55.8%, 68.8% and 74.2% respectively) were significantly higher than in conventional group (29.9%, 56.5% and 54.0%, all P<0.05). After 36 and 54 months′ treatment, the target arrival rate of HbA1c< 6.5% (73.1% vs 24.3% and 80.3% vs 24.6%,all P<0.05) was significantly higher in the intensified group than in conventional group. Blood pressure, fasting blood-glucose, HbA1c, cholesterol, HDL-C, and monthly medical cost were all different significantly among baseline, 18, 36 and 54 months′ treatment (all P<0.05). The target arrival rates of blood pressure at baseline and 18, 36 and 54 months treatment were 57.6%, 59.3%, 60.5% and 83.1% in the intensified group and 46.2%, 55.8%, 73.1% and 80.3% in the conventional group. The percentages of intensified group with cholesterol < 5.17 mmol/L were 42.1%, 68.8%, 63.2%, 62.9%, respectively ,and those with HDL-C target arrival were 70.5%,87.5%, 81.6% and 81.4%. All of lipids profiles levels were much better in intensified group than in conventional group.In intensified versus conventional group, the overall proportion of medication was less for biguanides (56% vs 67%) and was more for sulfonylurea (70% vs 21%) and insulin (54% vs 12%)(all P<0.05). The medical cost was increased by 134.5 yuan (54%) and 70.5 Yuan RMB (30%) monthly per person in the intensified group and in conventional group respectively. Conclusion The intensified community-based treatment shows a better therapeutic effect in controlling hyperglycemia, hypertension and dyslipidemia than the conventional treatment, but with slightly increased monthly medical cost.

Objective To evaluate the efficacy of metformin and diet fibre intervention in preventing the conversion of impaired glucose tolerance (IGT) to type 2 diabetes mellitus.Methods The recruited 293 IGT subjects were diagnosed by 75 g OGTT (WHO, 1985), with their age more than 35 years and BMI more than 19 kg/m 2. They were divided into 4 groups, i.e. control (C) (72 cases), education (E) (57 cases), diet fibre (DF) (84 cases) and metformin (M) (80 cases) groups. The subjects of group E were given healthy diet education. The subjects of group DF were treated with diet fibre 12g daily, and group M were given metformin 0.75 g daily. 75 g OGTT was done every 6 months. They were followed 3 years. The primary end point was the development of diabetes based on 2 hour plasma glucose after 75 g glucose load. Results The IGT subjects consisted of 216 males and 77 females. 23 subjects (7.8%) were discontinued prematurely. At the end of the study, the fasting blood sugar (FBS) and post OGTT 1 hour glucose levels were slightly higher in group C, E, DF than baseline data, while both above glucose levels were significantly lower than baseline in group M( F=8.118, P<0.001, F=3.697, P= 0.012). The cumulative cases with conversion to diabetes were 16 (25.0%) in group C, 11(21.6%) in group E, 13(16.3%) in group DF, and 7( 9.33% ) in group M. Using the Chi square test the conversion rate of diabetes was significantly lower in group M than group C. The diabetes conversion rate was positively related to the age and FBS ( P <0.05) and was negatively related to the intervention methods ( P =0.013) using mono factor statistical analysis. And the diabetes conversion rate was positively related to the FBS( P = 0.03 ), and was negatively to the intervention methods ( P =0.034) using multi regression analysis. Conclusion Metformin is effective in delaying the conversion of IGT to type 2 diabetes mellitus. The diet fibre may also be effective in IGT intervention.

如何对IGT患者进行有效的干预治疗,防止其转化为DM,甚至使IGT逆转正常的研究是DM预防中的重要一环.为此,我校医院与301医院联合,从1996年对52例IGT患者进行为期三年的二甲双胍干预及对照观察,现将结果报告如下.