CAJ | 학술논문

目的分析个体化降糖治疗策略对早期诊断2型糖尿病患者血糖控制的影响.方法对2002年6月至2003年5月全国10家三甲医院内分泌科病房中的1396例2型糖尿病患者用药及血糖控制情况进行回顾性分析,均为新诊断或病程在1年之内的患者,年龄(51±9)岁,体质指数(BMI)为(24.9±3.0) kg/m2.治疗方案根据复杂程度分为未用药(A组)、单种口服药(B组)、口服药联合治疗(C组)及含胰岛素的治疗(D组)四种情况,分析治疗方案调整前、调整后及干预开始后随访20个月间对患者血糖的影响.计数资料与计量资料组问比较分别采用X2检验和协方差分析,干预前后比较使用配对t检验.影响血糖疗效的相关因素分析采用Pearson相关分析.结果 (1)治疗方案调整前患者空腹血糖为(7.5±2.4)mmol/L、糖化血红蛋白(HbAlc)为(7.3±1.9)％.经干预后随访第20个月时患者空腹血糖为(6.7±1.6) mmol/L,HbAlc为(6.1±1.4)％.(2)对HbAlc＞7％的患者,磺脲类和(或)双胍类单药或联合治疗是本研究中临床医师最常选用的治疗方式,其HbAlc的达标率分别为79.2％、81.9％,二者差异无统计学意义(X2=0.445,P＞0.05).(3)随访期末的HbAlc水平与患者的年龄(r=0.087,P＜0.01)、起始HbAlc水平(r=0.228,P＜0.001)呈显著正相关关系.与治疗方案的复杂性接近正相关,但是差异没有统计学意义(r=0.054,P＞0.05).与性别、体重、BMI及高血压病史等均无相关性(r值分别为:0.053、0.011、0.019和-0.034,均P＞0.05).结论 2型糖尿病患者早期以传统口服降糖药为主的个体化治疗可以长期、有效、安全地控制血糖.对起始血糖较高的患者应采取更为积极的胰岛素强化方案.
목적 분석개체화강당치료책략대조기진단2형당뇨병환자혈당공제적영향.방법 대2002년6월지2003년5월전국10가삼갑의원내분비과병방중적1396례2형당뇨병환자용약급혈당공제정황진행회고성분석,균위신진단혹병정재1년지내적환자,년령(51±9)세,체질지수(BMI)위(24.9±3.0) kg/m2.치료방안근거복잡정도분위미용약(A조)、단충구복약(B조)、구복약연합치료(C조)급함이도소적치료(D조)사충정황,분석치료방안조정전、조정후급간예개시후수방20개월간대환자혈당적영향.계수자료여계량자료조문비교분별채용X2검험화협방차분석,간예전후비교사용배대t검험.영향혈당료효적상관인소분석채용Pearson상관분석.결과 (1)치료방안조정전환자공복혈당위(7.5±2.4)mmol/L、당화혈홍단백(HbAlc)위(7.3±1.9)％.경간예후수방제20개월시환자공복혈당위(6.7±1.6) mmol/L,HbAlc위(6.1±1.4)％.(2)대HbAlc＞7％적환자,광뇨류화(혹)쌍고류단약혹연합치료시본연구중림상의사최상선용적치료방식,기HbAlc적체표솔분별위79.2％、81.9％,이자차이무통계학의의(X2=0.445,P＞0.05).(3)수방기말적HbAlc수평여환자적년령(r=0.087,P＜0.01)、기시HbAlc수평(r=0.228,P＜0.001)정현저정상관관계.여치료방안적복잡성접근정상관,단시차이몰유통계학의의(r=0.054,P＞0.05).여성별、체중、BMI급고혈압병사등균무상관성(r치분별위:0.053、0.011、0.019화-0.034,균P＞0.05).결론 2형당뇨병환자조기이전통구복강당약위주적개체화치료가이장기、유효、안전지공제혈당.대기시혈당교고적환자응채취경위적겁적이도소강화방안.
Objective To analyze the early therapy strategy on glucose control in type 2 diabetic patients.Methods From June 2002 to May 2003,the medication and blood glucose control in 1396 cases with type 2 diabetes in national 10 grade 3A hospitals were retrospectively analyzed.The patients were diagnosed newly or within one year in CDCPS (Chinese Diabetes Complication Prevention Study),with (51 ± 9) yrs,body mass index (BMI) (24.9 ± 3.0) kg/m2.Besides the same instruction of lifestyle intervention,the patients were further divided as four groups:without intervention (group A),single oral hypoglycemic agent (group B),combined oral hypoglycemic agents (group C) and treatment including insulin(group D).The X2 test and analysis of covariance was used for count data and measurement data between groups.The paired t test was used comparison before and after the intervention.Pearson correlation analysis was used for factors affecting the efficacy of glucose analysis.Results (1) The level of HbA1 c at baseline was (7.3-± 1.9)％,and the fasting blood-glucose(FBG) was (7.5 ± 2.4)mmol/L among the four intervention group betore the treatment adjusted.After 20 months of follow-up,the mean FBG and HbAlc reached to (6.7-± 1.6) mmol/L and (6.1 ± 1.4) ％,respectively.(2) For patients with HbAle ＞ 7％,sulfonylurea and (or) biguanide monotherapy or combination therapy in this study was the most frequently chosen treatment.Compliance rates of HbAlc were 79.2％,81.9％,respectively.The difference was not statistically significant.(3) HbA1 c levels at the end of the follow-up and the patient's age (r =0.087,P ＜0.01),initial HbAlc levels (r =0.228,P ＜ 0.001) showed a significant positive correlation.But HbA1 clevels showed no correlation with body weight,BMI and hypertension(r =0.053,0.011,0.019,-0.034,all P ＞ 0.05).Conclusion According to the levels of glucose and HbA1 c,the early individualized therapy strategy mainly based on sulphanylureas and/or biguanides is proved to be persistently effective and safe in newly diagnosed type 2 diabetic patients.More positive treatment should be recommended to the patients with higher HbAlc level.