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据统计,我国每10个成年人中就约有1名糖尿病患者,全国总患者数接近1亿,
上海市糖尿病患者人数也接近250万,这已经成为上海最沉重的疾病负担之一。专项调查显示,上海市糖尿病知晓率不断上升,达到68%,意味着即100个糖尿病患者中有68人知道自己患有糖尿病,但尚有三分之一病人不知道自己患有糖尿病,而人群的血糖控制率、并发症筛查率等仍亟待进一步提高。 2014年,上海市政府将“糖尿病的预防和诊治服务体系建设”这一项目由上海市第六人民医院院长、上海糖尿病研究所贾伟平教授领衔,由上海市第六人民医院会同上海市疾病预防控制中心、上海市眼病防治中心等共同组织实施。如何在社区层面,开展慢性并发症的筛查,是糖尿病并发症诊治的基础。2007年3月起,上海第六人民医院贾伟平教授团队率先在国内创建并先后在普陀等5个区7个社区卫生服务中心试点建设医院-社区糖尿病无缝化管理模式。患者的血糖良好达标率从管理前的13.3%上升到管理后的31.8%,患者对糖尿病的知识知晓率从管理前41.5%提高到78%。 上海市卫生计生委表示,上海在国内首创了医院-社区糖尿病一体化管理的模式,曾在曹杨社区卫生服务中心开展试点,如今已在16个区240个社区卫生服务中心建立了糖尿病无缝化管理模式和防、治、研一体化防治体系。 此外,在既往医院-社区一体化的工作基础上,依托“健康云”平台信息,上海市居民可以进行糖尿病风险评估,对筛查出的患者开展“以患者为中心”的全程健康管理服务。
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