CAJ | 학술논문

目的了解北京城区社区2型糖尿病患者管理3年降糖药物调整情况及影响血糖达标的相关因素.方法 2008年8月至2011年7月对在北京城区社区就诊的3201例2型糖尿病患者定期随访,进行血糖、血压血脂综合达标管理.依据管理3年前后降糖药物调整情况分为4组:增加胰岛素组(255例)、增加口服降糖药组(641例)、降糖药不变组(1621例)及降糖药减少组(684例),观察各组血糖达标情况.结果管理3年后,①4组患者糖化血红蛋白(HbA1c)分别从(8.3±1.9)％、(7.4±1.7)％、(6.8±1.3)％和(7.2±1.5)％,降至管理后的(7.5±1.5)％(t=5.38,P＜0.01)、(7.0±1.3)％(t=5.17,P＜0.01)、(6.7±1.2)％(t=2.62,P＜0.05)和(7.1±1.4)％(t=1.76,P＞0.05);HbA1c下降＞0.5％的患者比例分别为52.2％(133/255)、34.3％ (220/641)、24.6％(399/1621)和31.9％(218/684),增加胰岛素组血糖下降幅度最大;②管理前血糖未达标(HbA1c≥7％)的1280例患者中,管理3年后562例(43.9％)达标;③初等、中等、高等教育背景者管理后血糖达标率分别为61.5％(342/556)、64.7％(1174/1814)、74.5％(619/813);人均月收入＜2000元、2000～4000元、＞4000元者管理后的血糖达标率分别为58.1％(971/1670)、77.3％(828/1071)和66.8％(137/205);④多因素逐步回归分析显示,增加胰岛素、增加口服降糖药、人均月收入2000～ 4000元、管理后BMI下降幅度和年龄,与HbA1c下降独立相关,OR值分别为0.45、0.80、0.72、0.96和1.08(P＜0.05).结论通过3年积极调整降糖药物,2型糖尿病患者血糖达标率明显提高,尤以增加胰岛素组血糖下降幅度最大.低收入、低教育程度者仍是血糖达标关注的重点.
목적 료해북경성구사구2형당뇨병환자관리3년강당약물조정정황급영향혈당체표적상관인소.방법 2008년8월지2011년7월대재북경성구사구취진적3201례2형당뇨병환자정기수방,진행혈당、혈압혈지종합체표관리.의거관리3년전후강당약물조정정황분위4조:증가이도소조(255례)、증가구복강당약조(641례)、강당약불변조(1621례)급강당약감소조(684례),관찰각조혈당체표정황.결과 관리3년후,①4조환자당화혈홍단백(HbA1c)분별종(8.3±1.9)％、(7.4±1.7)％、(6.8±1.3)％화(7.2±1.5)％,강지관리후적(7.5±1.5)％(t=5.38,P＜0.01)、(7.0±1.3)％(t=5.17,P＜0.01)、(6.7±1.2)％(t=2.62,P＜0.05)화(7.1±1.4)％(t=1.76,P＞0.05);HbA1c하강＞0.5％적환자비례분별위52.2％(133/255)、34.3％ (220/641)、24.6％(399/1621)화31.9％(218/684),증가이도소조혈당하강폭도최대;②관리전혈당미체표(HbA1c≥7％)적1280례환자중,관리3년후562례(43.9％)체표;③초등、중등、고등교육배경자관리후혈당체표솔분별위61.5％(342/556)、64.7％(1174/1814)、74.5％(619/813);인균월수입＜2000원、2000～4000원、＞4000원자관리후적혈당체표솔분별위58.1％(971/1670)、77.3％(828/1071)화66.8％(137/205);④다인소축보회귀분석현시,증가이도소、증가구복강당약、인균월수입2000～ 4000원、관리후BMI하강폭도화년령,여HbA1c하강독립상관,OR치분별위0.45、0.80、0.72、0.96화1.08(P＜0.05).결론 통과3년적겁조정강당약물,2형당뇨병환자혈당체표솔명현제고,우이증가이도소조혈당하강폭도최대.저수입、저교육정도자잉시혈당체표관주적중점.
Objective To analyze the impact of antidiabetic drugs adjustment and other related factors on reaching target glucose in type 2 diabetic patients under community management.Methods Total 3201 patients with type 2 diabetes from 15 community health service centers in Beijing were enrolled in the study,who entered the community diabeta management program from August 2008 to July 2011.According to the glucose-lowering drugs adjustment during 3 years intervention period,patients were divided into 4 groups:255 patients (8.0％) in insulin-added group,641 (20.0％) in oral hypoglycemic drugs-added (OHA)group,1621 (50.6％) in hypoglycemic drug-constant group and 684 (21.4％) in drug-reduced group.Results The hemoglobin Alc(HbAlc) levels were reduced from(8.3 ±1.9)％,(7.4 ±1.7)％,(6.8±1.3)％ and(7.2±1.5)％ to (7.5±1.5)％ (t =5.38,P＜0.01),(7.0±1.3)％(t=5.17,P＜0.01),(6.7±1.2)％(t=2.62,P＜0.05)and(7.1±1.4)％(t=1.76,P＞0.05),respectively in above 4 groups after 3 years management; the rates of HbAlc-reduction ＞ 0.5％ unit were 52.2％ (133/255),34.3％ (220/641),24.6％ (399/1621) and 31.9％ (218/684),respectively.In 562 (43.9％) out of 1280 cases whose HbA1c ≥7％ before entering the management program,the HbA1c levels reached to ＜ 7.0％ (P ＜ 0.01) ; the rate of reaching recommended target of HbA1c (48.4％) was significantly higher in OHA group than that of other 3 groups.After 3 years management the blood glucose control rates in patients with low,middle and high educational backgrounds were 61.5％ (342/556),64.7％ (1174/1814)and 74.5％ (619/813); those in patients with low,middle and high economic levels were 58.1％ (971/1670),77.3％ (828/1071) and 66.8％ (137/205),respectively(P ＜ 0.01).Multivariant logistic regression analysis showed that adding insulin,adding OHA,per capita income ￥2000-4000/M,BMI reduction during management period and age of patients were independent related factors for decrease in HbAlc,with odds ratio (OR) of 0.45,0.80,0.72,0.96 and 1.08(P ＜0.05).Conclusion By management of hypoglycemic drugs actively,patients with type 2 diabetes in Beijing communities show significant improvement in HbAlc levels from 2008 to 2011,but the low educational back ground and low-income groups still should be the primary focus.