2型糖尿病血糖控制未达标患者现状调查报告

A survey on the current status of type 2 diabetic patients who failed to achieve the glycemic control target

目的调查2型糖尿病血糖未达标患者的现状，为制定应对策略提供理论依据。方法2010年8至10月，收集全国26个城市181家医院血糖未达标的2型糖尿病患者进行问卷调查，调查未达标患者的血糖水平、生活方式干预、血糖监测、药物使用情况等，得到资料比较完整的问卷3861份，分析患者未达标原因。结果在统计的未达标患者中，HbA1c均值7．9％，空腹血糖均值8．2mmol／L，餐后血糖均值11．5mmol／L。生活方式干预方面，仅25．6％的患者能按医嘱严格进行饮食控制，44．5％的患者基本不进行体育锻炼。分别有35．8％和47．8％的患者不进行空腹和餐后血糖的监测。60岁以上的患者，血糖控制水平与其他年龄组并无差别，但其低血糖发生率高达35．5％，较其他两组（分别为20．8％和21．4％）明显为高（均P〈0．05）。药物治疗方面，单药治疗及联合治疗患者比例分别为46．1％和51．7％。〉60岁的老年组联合用药比例更高（58．7％，与其他年龄组比，P〈0．05）。75％的患者进行了治疗方案的调整。结论药物治疗方案不够强化或不适当是患者血糖未达标的主要原因；另外，生活方式不佳，血糖监测不够，患者依从性差也是血糖未达标的重要原因。对于未达标患者，需要进一步强化患者教育，加强生活方式干预，选择更加强化，同时安全、依从性好的降糖治疗方案。对于老年患者降糖的目标值应适当放宽。

Objective To investigate the current status of type 2 diabetic patients who failed to achieve the glycemic control target, and provide theoretic evidences for making corresponding strategies. Methods The 2 diabetic patients who failed to reach the glycemic target were recruited from 181 hospitals in 26 cities and received a standard questionnaire, the conditions of their blood glucose level, lifestyle intervention, blood sugar monitoring, and drug therapy were recorded. Totally 3 861 questionnaires with complete information were collected. And the causes which account for glycemic control status were analyzed. Results Among these patients, the mean HbA1c was 7.9%, the mean fasting plasma glucose was 8.2 mmol/L, and the mean postprandial plasma glucose was 11.5 mmol/L. Only 25.6% of patients take their diet control strictly as prescribed and 44. 5% of patients have little exercise. 35. 8% and 47.8% of patients did not monitor their fasting and postprandial plasma glucose, respectively. Glycemic control in the patients aged 〉 60 years was similar to the younger patients, but the hypoglycemia incidence in the eider group reached 35.5%, which was higher than those in the other 2 groups （20.8% and 21.4%, both P〈0.05 ）. The proportion of patients with mono-therapy and combination therapy was 46. 1% and 51.7%, while the proportion with combination therapy rose in the patients aged 〉60 years （58.7% ; Compared with the other age-groups, all P〈0.05 ）. 75 % of patients have adjusted their drug administration regimen since initial treatment. Conclusions Inadequate or inappropriate drug therapy regimen is a major cause responsible for this poor glycemic control status. In addition, the unhealthy life styles, insufficient blood sugar monitoring, and poor compliance were also important causes. Thus, for these patients, it is necessary to further enhance patients＇ education, to improve life style intervention, as well as to select more effective, safer, and compliant drug therapy regimens. Finally, the glycemic control target for the elder patients should be more flexible.