我国四城市糖尿病肾病早期防治服务需要和利用现况分析

Analysis on the early control and prevention of diabetes nephropathy in China

目的通过对四城市糖尿病患者早期防治糖尿病肾病(DN)的预防保健服务需要和利用现状的调查,分析糖尿病患者在早期防治中存在的主要问题,为DN早期防治措施的有效实施,改进预防保健服务质量提供科学依据。方法选取2005年杭州、重庆、济南和武汉市7家综合医院和4家社区卫生服务中心门诊的2型糖尿病患者,询问患者发生各类并发症、DN相关代谢指标控制状况和综合治疗情况,并进行体格检查。结果 1 207例糖尿病患者中,64.12%的对象在确诊糖尿病时至少发生1种并发症,36.95%至少发生2种并发症。约一半患者血糖、血压控制不达标,76.2%和86.3%的患者血糖和血压控制不理想,近一半调查对象新发现尿微量白蛋白阳性。多数患者能至少每月测量1次血压(67.02%)。约1/4调查对象实施药物、饮食、运动、糖尿病教育和血糖监测五项治疗措施均为好。每年至少检测1次糖化血红蛋白和尿微量白蛋白的患者为14.41%和23.53%。极少患者定期复查血压、血脂、糖化血红蛋白和尿微量白蛋白四项指标均为好(0.68%)。结论被调查糖尿病患者DN早期防治服务需要和利用间存在较大差距,与指南推荐要求差距大,建议在规范医护人员临床诊疗和预防保健服务的同时,加强患者教育,提高早期防治DN的认知水平和自我管理能力。

Objective To learn the situation of the early control and prevention of diabetes nephropthy（DN） among provincial capital residents and provide evidence for improving health services to patients with diabetes.Methods We randomly selected diabetes patients from 7 hospitals and 4 community health service centers in Hangzhou,Chongqing,Ji′nan and Wuhan.Each participant had a questionnaire survey and physical examination.Results A total of 1 207 residents with diabetes were enrolled for the study.Single and multiple diabetes-related complications were respectively found in 64.12% and 36.95% of the patients at the beginning of diagnosis.Only half of participants controlled fasting blood glucose（FBG）and blood pressure（BP）well.Around 76.17% and 86.27% of participants failed to control FBG and BP.Almost half of urine samples had the concentration of new albumin equal or greater than 20mg/L among the participants.A quarter of participants followed the five recommended diabetes treatment strategies including medication compliance,diet control,physical exercise,the participation of diabetes control education and regular blood sugar monitoring.Annual HbA1c and MAU tests were completed in 14.41% and 23.53% participants.Conclusion The early control and prevention of DN need to be improved.It is necessary to provide diabetes patients with the education of early DN prevention and control,as well as the diabetes self-management.