门诊2型糖尿病合并代谢综合征患者的综合控制达标情况及影响因素调查

Investigation on the detection rate and control situation of metabolic syndrome with type 2 diabetes mellitus in outpatients

目的了解门诊2型糖尿病患者合并代谢综合征(MS)的检出率、整体治疗水平和控制达标情况,并分析其影响因素。方法 2009年6月～2009年12月连续收集679例门诊2型糖尿病患者的临床资料,包括人口学、体格检查、生化指标等,对不同专科的内科住院医师诊断和处置MS的水平进行分析。结果门诊2型糖尿病患者合并MS者占62.3%,女性为64.5%,男性为60.2%,>50岁的女性检出率明显高于男性;合并异常组分中肥胖比率最高(77.2%),其次是高血压(49.0%)、血脂紊乱(46.5%)。90.2%的糖尿病患者伴发其他代谢异常组分。Logistic回归分析发现检出率与代谢异常家族史、女性成正相关,OR值分别为1.48和1.92(P<0.05),而与运动治疗成负相关,OR值为0.68(P<0.05)。糖尿病患者中血糖、血压、血脂的药物治疗率分别为70.3%,73.9%和23.1%。门诊患者糖化血红蛋白、血压和血脂4项达标率分别为31.8%、27.0%和12.6%。接受过糖尿病教育的患者各指标达标率均高于未接受教育的患者。门诊内分泌专科医师对糖尿病之外MS其他相关各项代谢异常的诊断(诊断率40%～50%)和处置(处置率20%～30%)水平均低。结论门诊2型糖尿病患者MS检出率较高,整体治疗水平和达标情况较差,开展健康教育,尤须加强综合管理并提高门诊医生的处置水平以促进各代谢异常组分达标。

Objective To investigate the detection rate of metabolic syndrome（MS）with type 2 diabetes mellitus（T2DM）,the overall treatment level and the control condition of outpatients. Methods Totally 679 outpatients with T2DM admitted from June 2009 to December 2009 were investigated with designed questionnaire. Clinical data including demography,physical examination and biochemical indicator were collected. All data were statistically analyzed. Results The detection rate of MS in the diabetic outpatients was 62.3% in total, 64.5% in female and 60.2% in male respectively. The proportion of obesity was 77.2%, the highest in the abnormal metabolic components,and the proportion of hypertension and dyslipidemia were 49.0% and 46.5%. 90.2% of the diabetes patients were combined with other abnormal metabolic components. Logistic regression analysis showed the detection rate was different in residents with different family histories,gender,and exercise habit. The OR were 1.48,1.92 and 0.68,respectively. 70.3% of the diabetic patients used medicine to control their blood glucose,73.9% of 246 patients who had hypertension received medicine to control their blood pressure,and 23.1% of 316 patients who had dyslipidemia took medicine to control blood lipid. Among these patients,31.8%,27.0% and 12.6% can reach the ideal control level of blood glucose,blood pressure and blood lipid,respectively. The patients who have received formally diabetic education had more satisfactory effect than the patients who had no education history. The detection rate of other parameters besides diabetes mellitus by outpatient specialist major in endocrinology was lower,about 40%～50%. When it came to the treatment level,the rate was lower as well,about 20%～30%. Conclusions The detection rate of MS was higher in the diabetic outpatients. It is hard to get an ideal result on controlling the abnormal metabolic components even if several drugs had been used. The integrated management of diabetic patients should be emphasized. Healthy education should be organized to control these diseases.