苏州市金阊区2型糖尿病患者自我管理水平及其与糖化血红蛋白的关系

Relationship between self-management level and glycosylated hemoglobin A_(1C) level of patients with type 2 diabetes mellitus in Jinchang district of Suzhou city

目的探讨社区2型糖尿病患者自我管理水平及其与糖化血红蛋白（HbA1C）水平的关系，为苏州市社区糖尿病预防控制提供依据。方法于2012年4—5月，按照整群随机抽样的方法，在苏州市金阊区随机抽取4个街道社区（村），以年龄〉t35岁并且病程至少1年的890例2型糖尿病患者为研究对象。采用问卷调查的方式收集人口统计学和行为相关资料，并采集血标本进行血脂、血糖和HbA1C等指标检测。采用单因素logistic回归模型分析自我管理相关因素与HbA，。水平之间的关系。结果研究对象中34．3％的患者HbA，。达标（HbA，c〈7．0％o男性中吸烟、饮酒的比例分别为36．8％和22．8％，调查对象超重、肥胖者[体质指数（BMI）≥25．0kg／mz]占49．2％，知晓糖尿病知识、规律体育锻炼、控制饮食、遵从医嘱及监测指尖血糖≥1次倜的比例分别为78．8％、17．2％、25．8％、19．5％和23．0％。单因素logistic回归分析结果及调整年龄、性别、病程和药物治疗方式后的结果均显示，遵医嘱和每3-6个月检测1次HbA1C是HbA1C达标的保护因素，而超重、肥胖是其危险因素，多因素调整后OR值分别为1．78（95％口：1．14～2．51）、2．52（95％CI：1．60～4．Oo）和0．66（95％CI：0．50—0．89）。结论金阊区社区糖尿病患者的自我管理水平低，HbA1C达标率低，需要进一步加强行为干预。遵医嘱和每3-6个月检测1次HbA1C有助于HbA1C水平达标。

Objective To explore the relationship between self-management level and glycosylated hemoglobin Arc （HbAtc） level of patients with type 2 diabetes mellitus （T2DM） in communities and to provide the bases for preventing and controlling T2DM in communities of Suzhou city. Methods The random sampling method was used to select 890 patients （ I〉 35 years old） with T2DM for at least one year from four communities in Jinchang district of Suzhou. The data on demographic characteristics and behaviors were collected with questionnaire. The blood lipid, blood glucose and HbAlc of all subjects were detected. The relationship between self-management factors and HbAc level was assessed by logistic regression analysis. Results The HbAlc levels in 34.3 % DM patients were lower than 7.0 %. The rates of smoking and drinking in DM patients were 36.8 % and 22.8 %, respectively. BMI in 49.2% DM patients was I〉25.0 kg/m2. The proportions of DM awareness, exercise, control diet, compliance behavior and monitoring blood glucose （ t〉 1 time/week） were 78.8%, 17.2%, 25.8%, 19.5% and 23.0%, respectively. After adjusted for age, sex, the duration of diabetes and drug therapy, the single factor logistic regression analysis showed that the compliance with doctor advice and monitoring HbAc per 3-6 months were the important protective factors for normal HbAlc level, and overweight or obesity was risk factor, the OR values were 1.78 （95%CI： 1.60-2.51）, 2.52 （95%CI： 1.60-4.00） and 0.66 （95%CI： 0.50--0.89）, respectively. Conclusion The self-management level and glycemic control level of DM patients in Jinchang communities are low. The effective measures should be taken for changing patients＇ life style. The compliance with doctor advice and monitoring HbAc per 3-6 months can improve the HbAc level of DM patients.