目標：許多研究評估「糖尿病醫療給付改善方案」之成效，然而這些評估多缺乏對照組，且較少著墨於偏遠鄉鎮的個案。本研究藉由比較共同照護網參與組和對照組重複測量資料，評估糖尿病共同照護網對偏遠地區中老年患者相關代謝指標的長期控制成效。方法：以回溯式研究法進行資料收集及分析。資料來源為中台灣某地區醫院2002年12月至2007年7月之門診個案。採共變量分析(ANCOVA)比較兩組在二時間點上的差異，並以混合模式(mixed models)比較兩組的變化趨勢。結果：參與組的空腹血糖控制在參與照護網約三個月後與對照組呈現顯著差異；糖化血色素、總膽固醇和三酸甘油酯則在參與照護網約九個月後與對照組有顯著差異。結論：糖尿病共同照護網對於改善個案之糖化血素、空腹血糖、總膽固醇和三酸甘油酯的成效佳，對高、低密度脂蛋白膽固醇的改善效果則不明顯。多數患者在多項代謝指標的控制上，仍未達美國糖尿病學會的建議目標。參與組的長期控制成效明顯較佳，建議患者應長期且持續接受適當的衛教和照護介入。

Objectives: Many studies have been proposed to evaluate the effectiveness of the diabetes mellitus medical benefit improvement project in Taiwan. Most of these evaluations, however, lack a control group and pay little attention to rural areas. To evaluate the long-term effectiveness of the Diabetes Shared Care Network on related metabolic indices for diabetic patients in a rural area, we compared repeat measurements from the intervention group and a non-intervention group. Methods: Subjects were identified retrospectively from a database of outpatients with diabetes mellitus in a regional hospital in Mid-Taiwan between December 2002 and July 2007. Analysis of covariance (ANCOVA) and mixed models were used to demonstrate differences and trends in the related metabolic indices of the two groups. Results: The difference in fasting blood sugar levels between the two groups was significant after 3 months of network intervention. After 9 months, hemoglobulin A1C (HbA1C), total cholesterol, and triglycerides also showed significant differences. Changes in high density lipoprotein cholesterol and low density lipoprotein cholesterol did not. Conclusions: The effectiveness of the Diabetes Shared Care Network in improving HbA1C, fasting blood sugar, total cholesterol, and triglyceride levels was significant. For most patients; however, the related metabolic indices did not achieve the target suggested by the American Diabetes Association. In conclusion, the Diabetes Shared Care Network was somewhat effective in improving metabolic indices and can still serve as a model for the longterm education and care of diabetic patients.

偏遠地區;糖尿病;共同照護網;醫療給付改善方案;代謝指標

rural area, diabetes mellitus, Diabetes Shared Care Network, medical benefit improvement project, metabolic indices