CAJ | 학술논문

目的了解北京市部分社区40岁以上2型糖尿病患者血糖达标率的现状.方法 2011年12月至2012年8月在北京的三个社区(古城社区、金鼎社区、老山社区)的卫生服务中心通过普查的形式对40岁以上人群19 470名进行2型糖尿病相关的调查.符合标准的2 534名居民接受问卷调查、体格检查、实验室检查[肝肾功能、血糖、血脂、糖化血红蛋白(HbA1c)]等项目.选择人群中问卷调查结果为2型糖尿病(T2DM)的居民,以HbA1c＜7％为达标标准对其进行血糖达标率的分析,组间比较采用t检验及方差分析,logistic回归模型分析与血糖达标率可能相关的因素.结果共入选2 523例2型糖尿病患者,平均HbA1c为(7.4±1.8)％,其中血糖达标率为45.7％.调查中发现仅用口服降糖药组、仅用胰岛素组、胰岛素+口服降糖药组的平均HbA1c分别为(7.4+1.6)％、(7.9±2.2)％、(7.9±2.0)％,达标率分别是47.2％(568/1 203)、32.5％(87/268)、26.4％(73/276);单药降糖、双药降糖以及3种以上降糖药物控制的患者的HbA1c分别为(7.3±1.5)％、(7.5±1.9)％、(7.5±1.2)％,血糖达标率分别为45.0％(472/1049)、39.6％ (149/376)、37.0％(20/54).病程＜1年、1～5年、5～ 10年、≥10年的患者HbA1c分别为(7.0±1.5)％、(7.1±1.6)％、(7.4±1.8)％、(7.8±1.9)％,达标率分别为56.4％(195/346)、55.5％(422/760)、44.7％(266/595)、32.8％(270/822).logistic回归分析结果显示女性、体质指数、腰臀比、收缩压、并发症/伴发症、糖尿病病程、治疗方案与HbA1c达标率呈现相关性(OR=1.320、0.762、0.027、0.992、1.264、0.431、0.432,均P＜0.05).结论社区40岁以上人群中T2DM患者血糖达标率不足一半.随着糖尿病病程的延长,糖尿病的达标率不断下降.
목적 료해북경시부분사구40세이상2형당뇨병환자혈당체표솔적현상.방법 2011년12월지2012년8월재북경적삼개사구(고성사구、금정사구、로산사구)적위생복무중심통과보사적형식대40세이상인군19 470명진행2형당뇨병상관적조사.부합표준적2 534명거민접수문권조사、체격검사、실험실검사[간신공능、혈당、혈지、당화혈홍단백(HbA1c)]등항목.선택인군중문권조사결과위2형당뇨병(T2DM)적거민,이HbA1c＜7％위체표표준대기진행혈당체표솔적분석,조간비교채용t검험급방차분석,logistic회귀모형분석여혈당체표솔가능상관적인소.결과 공입선2 523례2형당뇨병환자,평균HbA1c위(7.4±1.8)％,기중혈당체표솔위45.7％.조사중발현부용구복강당약조、부용이도소조、이도소+구복강당약조적평균HbA1c분별위(7.4+1.6)％、(7.9±2.2)％、(7.9±2.0)％,체표솔분별시47.2％(568/1 203)、32.5％(87/268)、26.4％(73/276);단약강당、쌍약강당이급3충이상강당약물공제적환자적HbA1c분별위(7.3±1.5)％、(7.5±1.9)％、(7.5±1.2)％,혈당체표솔분별위45.0％(472/1049)、39.6％ (149/376)、37.0％(20/54).병정＜1년、1～5년、5～ 10년、≥10년적환자HbA1c분별위(7.0±1.5)％、(7.1±1.6)％、(7.4±1.8)％、(7.8±1.9)％,체표솔분별위56.4％(195/346)、55.5％(422/760)、44.7％(266/595)、32.8％(270/822).logistic회귀분석결과현시녀성、체질지수、요둔비、수축압、병발증/반발증、당뇨병병정、치료방안여HbA1c체표솔정현상관성(OR=1.320、0.762、0.027、0.992、1.264、0.431、0.432,균P＜0.05).결론 사구40세이상인군중T2DM환자혈당체표솔불족일반.수착당뇨병병정적연장,당뇨병적체표솔불단하강.
Objective To investigate the current status of the glycemic control in the patients aged 40 or older in the communities of Beijing.Methods Total of 19 470 people aged 40 years or older were enrolled to perform census in the present study from three communities,Gucheng,Jinding and Laoshan,of Beijing from December 2011 to August 2012.Each participant who met the standard received a questionnaire survey,physical examination and laboratory examination (liver and kidney function,serum lipid and hemoglobin glycosylated hemoglobin (HbA1c)).The glycemic control of the patient with type 2 diabetes mellitus(T2DM),which is reported in the questionnaire,was assessed according to the goal of HbA1c ＜ 7％ advocated by the American Diabetes Association (ADA) and the Chinese Diabetes Society.The t test and ANOVA analysis was used to compare the difference between groups.A logistic regression analysis was made to reveal the characteristics associated with patients attaining HbA1c ＜ 7.0％.Result Of the 2 523 patients with type 2 diabetes included in the survey,the mean HbA1c was (7.4 ± 1.8) ％ and patients who met the glycemic goal (HbA1c ＜ 7％) was 45.7％.The oral antidiabetic drugs (OADS) monotherapy,insulin monotherapy,OAD+Insulin groups had mean HbA1c levels of (7.4 ± 1.6)％,(7.9 ±2.2)％ and (7.9 ± 2.0) ％,respectively,and among those three groups,47.2％ (568/1 203),32.5％ (87/268),26.4％ (73/276) of the patients met the goal of HbA1c ＜ 7.0％.The mean HbA1 c of the patients,treated with oneOAD,twoOADsand more than three OADs,was (7.3±1.5)％,(7.5 ±1.9)％ and (7.5± 1.2) ％,respectively,while the percentage of patients who met the glycemic goal of HbA1c ＜ 7.0％ was 45.0％ (472/1 049),39.6％ (149/376) and 37.0％ (20/54).As the development of the diabetes,the average of the HbA1c among patients with the duration of less than one year,1-5 years,5-10 years and more than 10 years was (7.0±1.5)％,(7.1±1.6)％,(7.4±1.8)％ and (7.8±1.9)％ and the number of patients with the achievement of HbA1 c ＜ 7％ was 56.4％ (195/346),55.5％ (422/760),44.7％ (266/595) and 32.8％ (270/822).According to the result of the logistic regression analysis,mean HbA1c achievement of HbA1c ＜7.0％ was related to the female,body mass index,waist hip ratio,systolic blood pressure,complications/comorbidities,duration of diabetes and the therapeutic regimen (OR =1.320,0.762,0.027,0.992,1.264,0.431 and 0.432,P ＜ 0.05 all above).Conclusions More than half of the patients aged 40 or older with T2DM do not meet the target of glycemic control of HbA1c less than 7.0％ in the communities of Beijing.The glycemic goal rate is down as the duration of diabetes.