上海市2型糖尿病患者血糖控制的影响因素分析

Analysis on Influencing Factors for Achieving Glycemic Control in Patients with Type 2 Diabetes Mellitus in Shanghai

[目的]评价上海市2型糖尿病患者血糖控制情况,了解血糖控制的影响因素。[方法]采用随机抽样方法,在210个社区抽取2型糖尿病患者1710人,开展问卷调查和体格检查,得到有效问卷1624份。分别依据美国糖尿病协会(ADA)和中华医学会糖尿病学分会(CDS)标准评估2型糖尿病患者的血糖、血压和血脂的控制情况。根据ADA的血糖控制目标[糖化血红蛋白(HbA1c)<7%],将被调查者分为血糖控制组和血糖控制不良组,运用多因素非条件Logistic回归分析,探讨血糖控制的影响因素。[结果]1624例2型糖尿病患者的HbA1c平均值为7.5%。根据CDS的控制目标,27.9%的患者HbA1c达标(<6.5%),5.1%的患者HbA1c、血压(Bp)和低密度脂蛋白胆固醇(LDL-C)(HbA1c<6.5%,BP<130/80mmHg,LDL-C<2.5mmol/L)均达标。根据ADA控制目标,43.6%的患者HbA1c达标(<7.0%),9.9%的患者三者(HbA1c<7.0%,BP<130/80mmHg,LDL-C<2.6mmol/L)均达标。多因素Logistic回归分析结果显示,影响血糖控制效果的因素有年龄小、病程长、居住地为郊区、不控制饮食及腰臀比(WHR)大。[结论]目前上海市2型糖尿病血糖控制达标率较低,血糖控制受多种因素影响。

[ Objective ] To evaluate the glycemic control and identifying factors for achieving such control in patients suffered from type 2 diabetes mellitus in Shanghai. [ Methods ] A questionnaire survey and physical examination were conducted in patients with type 2 diabetes from 210 communities through a random sampling method. The criteria of American Diabetes Association （ ADA ） and China Diabetes Society （ CDS ）, respectively, were applied to evaluate the control of glycemic, blood pressure and blood lipid. Logistic regression analysis was used to analyze factors for achieving the target goal of glycemic control （ HbAlc〈7.0% ）recommended by ADA. [ Results ] The mean HbAI,, concentration of 1624 patients with type 2 diabetes was 7.5%. Based on the recommended targets of CDS, 27.9% of the participants achieved the goal of HbA1c level less than 6.5%, whereas 5.1% of the participants achieved all three target goals of HbAIc level less than 6.5%, blood pressure less than 130/80 mmHg, and low-density lipoprotein cholesterol level less than 2.5 mmol/L. According to ADA, 43.6% of participants had a HbAlo 〈 7.0% and 9.9% of participants attained all three recommended targets （ HbA1c〈7.0%, blood pressure （ BP ）〈130/80 mmHg, low-density lipoprotein cholesterol（ LDL-C ）〈2.6mmol/L ）. Age, residence, disease duration, medical nutrition therapy（ MNT ）and waist-to-hip ratio（ WHR ） were influencing factors for achieving the HbAlc goal. [ Conclusion ]The success rate of glycemic control was low in patients with type 2 diabetes mellitus in Shanghai. There are muhifaceted determinants for achieving glvcemic control.