糖尿病慢性并发症与糖尿病治疗关系的调查

Chronic diabetic complications and treatments in chinese diabetic patients

调查糖尿病并发症检出率及饮食和药物治疗满意度。方法采取预约、集中检查的方式，对糖尿病患者进行有关糖尿病、眼科、肾内科、神经内科、心内科等方面的临床和生化检查及饮食和药物治疗情况调查。结果６２６例糖尿病患者主要并发症及合并症检出率依次为：高血压（４９．６％）、神经病变（４６．５％）、视网膜病变（３７．０％）、缺血性心脏病（２５．４％）、蛋白尿（２２．８％）、脑梗塞（１２．３％）、足坏疽（１．０％）。约一半的患者血糖控制不满意。２４％、４８％和５９％的患者有高胆固醇、高甘油三酯血症和低高密度脂蛋白血症。一半患者不能控制饮食。４０％的患者尽管血糖高而未能遵医嘱治疗。１２７例新确诊的糖尿病患者中分别有１９．６％、１７．８％和４２．５％的患者已有糖尿病视网膜病变、蛋白尿和神经病变。结论本组糖尿病患者确诊较迟，并发症及合并症检出率高，高血糖、高血脂、高血压得到控制者较少。饮食和降糖治疗的顺从性差。患者对糖尿病并发症或合并症的知晓率低。

Objective To investigate the prevalence of diabetes complications and the control of blood glucose, lipids and treatments in Chinese diabetic patients. Methods In 1994 1996, 626 Chinese diabetics were investigated for their diabetic complications, the control of blood glucose, lipids and their treatments by a multi disciplinary team which included diabetic specialists, ophthalmologists, neurologists, nephrologists, dieticians, cardiologists, and others. Results Of these patients, 49.6% had hypertension, 46.5% neuropathy, 37.0% retinopathy, 25.4% ischemic heart disease (including 2.3% with myocardial infarction), 22.8% proteinuria (including microalbuminuria), 12.3% cerebral infarction and 1.0% amputation. 16% had preproliferative and proliferative retinopathy, and 10.5% maculopathy. 28 patients (44 eyes) were blind, but only 29% of them were checked by ophthalmologists before this screening. 36% of these patients with antihypertensive agents had their blood pressure controlled. 60% patients with hypertension were not taking any antihypertensive agent, one third hypertensive patients had their blood pressure uncontrolled even if they had been treated with antihypertensive agents. Hyperglycemia was controlled unsatisfactorily in half of the patients. Over one fourth of the patients had severe hyperglycemia. 24%, 48% and 59% of the patients had hypercholesterolemia, hypertriglyceridemia and low HDL level respectively. 21.9% kept on diabetic diet and about one fourth had their diet uncontrolled, including 14% who had never controlled their diet even if their hyperglycemia was severe and 20% newly diagnosed diabetic patients untreated. One hundred twenty seven newly diagnosed patients with duration less than 1 month were investigated for their diabetic complications. 19.6%, 17.8% and 42.5% of them had retinopathy, proteinuria and neuropathy. Eight patients had preproliferative and 1 had proliferative retinopathy. Three patients (5 eyes) had maculopathy. 33% of these newly diagnoded patients had hypertension, 7 severe 作者单位:100101 北京,中国人民解放军第五一四医院 hypertension, including 3 patients with antihypertensive therapy.Conclusions Diabetes was found late in the Chinese patients and diabetic complications had occurred in some patients by the time the disease was diagnosed. Hypertension was common in the Chinese diabetics. Over half of the diabetics had their blood glucose and blood pressure uncontrolled. Most of the diabetic patients had not controlled their diet. Macrovascular diseases and abnormal lipids metabolism were common. The risks of diabetic complications such as smoking, obesity and hypertension were not controlled and the awareness of these risks was low in the Chinese diabetics.