门诊2型糖尿病患者374例代谢控制现状

Glycemic control in 374 outpatients with type 2 diabetes mellitus

目的分析我院门诊采用口服降糖药治疗的2型糖尿病(T2DM)患者血糖等代谢指标的控制现状。方法采用问卷调查方式收集374例长期在我院门诊随访的T2DM患者近3个月内的临床及实验室资料,根据服用的口服降糖药种数分为3组(单药治疗组、两药治疗组和三种及以上药物治疗组),评估各项代谢指标的控制现状及与并发症和合并症的关系。结果374例患者平均糖化血红蛋白(HbA1c)为(7.46±1.22)%,达标率40.64%。体质量指数(BMI)<24 kg/m2患者血糖控制较BMI≥24 kg/m2者好(P<0.05)。最常用的联合药物为磺脲类和双胍类药物(两药组占51.35%,三药及以上组占71.09%)。三药及以上药物治疗组HbA1c≥8.0%者比例(34.12%)超过合并后单药及双药组(20.86%),差异有统计学意义(P=0.005)。Logisitc回归分析表明病程长(OR值1.64)、BMI高(OR值1.60)、合并症或并发症数目多(OR值1.60)是血糖不达标的危险因素,而年龄则是保护因素(OR值0.695)。结论我院门诊口服降糖药治疗的T2DM患者HbA1c达标率较低,与"治疗惯性"等因素相关。联合用药治疗后血糖仍控制不佳者,应积极调整治疗方案。

Objective To analyze the glycemic control and other metabolic profiles in outpatients with type 2 diabetes mellitus （T2DM） who were only taking oral antidiabetic drugs （OADs）. Methods The clinical data and laboratory findings （past 3 months） of 374 T2DM outpatients who were followed up in our hospital were collected by questionnaire survey. The participants were grouped by the types of OADs they were taking （single drug group, two drug group, and three or more drug group）. The relationship of the control status of each parameter with complications or/and other metabolic abnormalities was analyzed. Results The mean glycosylated hemoglobin Ale （HbAlc） of these patients was （7.46 ±1.22）%, with 40. 64% of them achieving the recommended glycemic target （HbA1c 〈7. 0%）. Participants with body mass index （BMI） less than 24 kg/m2 achieved better glycemic control compared with those with BMI more than 24 kg/m2 （P〈0.05）. Sulphonylureas and biguanides were the most commonly used options, accounting for 51.35% in the two drug group and 71.09% in the three or more drug group. The proportion of participants with poorly controlled glycemic status （HbA1c 〈8.0%） in the three or more drug group （34.12 % ） was significantly higher than that of participants in the other two groups （20.86 %, P ： 0. 005）. Logistic regression analysis indicated that the long course of disease （OR= 1.64）, high BMI （OR=1.60） and the more comorbidities and complications （OR=1. 60） were the risk factors of poor glycemic control （all P〈0.01）, and age was a protective factor for glycemic control （OR=0. 695, P〈0. 01）. Conclusion The status of blood glucose control in the outpatients of our hospital is not satisfactory, which is due to factors such as ＂therapeutic inertia＂. When multidrug therapy fails to achieve the recommended glycemic targets, the treatment strategy should be adjusted promptly.