北京市社区2型糖尿病患者国家基本降糖药物覆盖率调查研究

A survey on the coverage rate of the antidiabetic drugs in the national essential medicine list amongpatients with type 2 diabetes in Beijing communities

目的了解北京市不同区域社区2型糖尿病（T2DM）患者所用国家基本药物目录中4种降糖药（国家基本降糖药：动物胰岛素、二甲双胍、格列吡嗪和格列本脲口服普通剂型）的覆盖率及血糖达标情况。方法2011年1月至3月对北京市4个社区卫生服务中心（苹果园、月坛、龙山和花乡社区）的904例T2DM患者进行现状问卷调查和抽血化验。采用X^2检验比较不同社区国家基本降糖药物的覆盖率。结果（1）4种国家基本降糖药物中二甲双胍普通剂型覆盖率最高，达40．5％（366／904），4个社区间差异有统计学意义（X^2=9．86，P〈0．05）；龙山社区最高为48．6％（121／249），月坛社区最低为36．2％（75／207）。（2）格列吡嗪普通剂型覆盖率为3．1％（28／904），4个社区间差异有统计学意义（X^2=56．14，P〈0．05）；花乡社区最高为14．3％（16／112），龙山社区最低为0。（3）格列本脲覆盖率0．6％（5／904），4个社区间差异无统计学意义（X^2=0．33，P〉0．05）。（4）动物胰岛素覆盖率0．2％（2／904）；花乡社区为1．8％（2／112），其余3个社区均为0。（5）患者总体血糖达标率[糖化血红蛋白（HbAlc）〈7％]为33．2％（300／904），4个社区间差异有统计学意义（X^2=73．79，P〈0．05）；月坛社区最高为55．1％（114／207），其次为苹果园社区33．0％（111／336）、龙山社区24．1％（60／249）、花乡社区13．4％（15／112）。结论北京市社区T2DM患者中，国家基本降糖药物使用覆盖率偏低，糖尿病患者总体血糖达标率不高，但较早实行社区医疗管理结合医院转诊模式的月坛和苹果园社区的血糖达标率较高。

Objective To investigate the coverage rate of the antidiabetic drugs in national essential medicine list and the status of glycemic control among patients with type 2 diabetes mellitus （T2DM） in Beijing communities. Methods A total of 904 patients with T2DM were selected from 4 community health service centers of Beijing. They were Pingguoyuan, Yuetan, Huaxiang and Longshan community health service centers, respectively. Questionaires and chemical examination were used among them. Chi-square test was used for data analysis. Results （ 1 ） The coverage rate of metformin （ 40. 5 % , 366/904 ） was the highest in the 4 national essential antidiabetic drugs, which in Longshan community （48.6% , 121/249 ） was significantly higher than that of the other 3 communities （ X^2 = 9. 86, P 〈 0. 05 ）. （ 2 ） The coverage rate of glypizide was 3. 1% （28/904）, which in Huaxiang community（ 14. 3%, 16/112） was the highest （ X^2= 56. 14 ,P 〈 0. 05 ） . （ 3 ） The coverage rate of glybenclamide was 0. 6% , the difference among the4 communities had no significance（ X^2 = 0. 33, P 〉 0. 05 ）. （4） The coverage rate of animal insulin was 0.2% （2/904）, which in Huaxiang community （1.8%, 2/112） was more than those of the other communities（0）. （5） The proportion of patients reaching the goal of glycated hemoglobin A1 c （HbAlc） 〈 7% was 33.2% （300/904）, which in Yuetan community （55.1%, 114/207） was more than that in Pingguoyuan （ 33.0% ）, Longshan （24. 1%, 60/249 ） and Huaxiang （ 13.4%, 15/112 ） communities （ X^2 = 73.79, P 〈 0. 05）. Conclusion The coverage rate of antidiabetic drugs in national essential medicine list is low in Beijing. Though the total proportion of patients reaching the goal of HbAlc 〈7% is not satisfied, the proportion in Yuetan and Pingguoyuan communities where the two-way referral between community health service centers and general hospitals has been established for a long time are satisfied.