兰州市社区中老年2型糖尿病患者糖化血红蛋白控制状况影响因素

The control status of glycosylated hemoglobin and its influencing factors in the middle aged and elderly patients with type 2 diabetes mellitus in Lanzhou communities

目的 了解兰州市社区中老年2型糖尿病（T2DM）患者糖化血红蛋白（HbA1c）控制状况并分析其相关影响因素.方法 整群抽取兰州市社区40～75岁已诊断为T2DM的患者1 120例纳入研究,对其进行问卷调查,并测量身高、体质量、血压、血脂及HbA1c,计算体质量指数（BMI）,进行统计分析.结果 1 120例患者中HbA1c达标（HbA1c＜7.0％）者453例,占40.4％（453/1 120）;未达标（HbA1c≥7.0％）者667例,占59.6％（667/1 120）.在单纯生活方式、一种口服药、多种口服药及胰岛素治疗的患者中,HbA1c达标率分别为49.2％（94/191）,45.7％（182/398）,41.5％（88/212）和27.9％（89/319）;伴超重（BMI 24.1～ 28.0 kg/m2）或肥胖（BMI＞ 28.0 kg/m2）、合并大血管或微血管并发症的患者HbA1c达标率低于不伴超重或肥胖、未合并大血管或微血管并发症的患者[38.6％ （192/498）,32.2％（49/152）比60.0％（12/20）,44.4％（200/450）; 32.7％（49/150）比41.6％（404/970）; 27.0％（85/315）比45.7％（368/805）],差异有统计学意义（P＜0.01或＜0.05）.多因素Logistic回归分析显示,糖尿病病程的延长、BMI的升高、合并微血管并发症及治疗方式逐步加强是HbA1c不达标的独立影响因素（P＜0.05）.结论 兰州市社区中老年T2DM患者HbA1c达标情况不容乐观;血糖的控制受多种因素的影响,故应进一步加强糖尿病管理,优化治疗方案,注重个体化综合治疗,以有效改善患者血糖控制状况.

Objective To investigate the control status of glycosylated hemoglobin （HbA1c） in the middle aged and elderly patients with type 2 diabetes mellitus （T2DM） in Lanzhou communities and analyze its influencing factors.Methods A total of 1 120 individuals having diagnosed T2DM aged 40-75 years in Lanzhou communities were selected.Questionnaire was conducted.Height,weight,blood pressure and lipid were examined.Body mass index （BM1） was calculated.The index were analyzed.Results The patients with HbA1c less than 7.0% were 453 cases （40.4%,453/1 120）,and HbA1c more than or equal to 7.0% were 667cases （59.6%,667/1 120）.The target rate of HbA1c in the patients receiving life style,one oral antidiabetic drug,more oral antidiabetic drug,insulin therapy were 49.2%（94/191）,45.7%（182/398）,41.5%（88/212） and 27.9%（89/319）,respectively.The target rate of HbA1c were 38.6%（192/298）,32.2%（49/152）,32.7%（49/150）,27.0%（85/315） in the patients overweight or obese,with macro or micro vascular complication,and 60.0% （12/20）,44.4%（200/450）,41.6%（404/970）,45.7%（368/805） in the patients without overweight or obese and macro or micro vascular complication,and there were significant differences （P 〈 0.01 or 〈 0.05）.Multivariate Logistic regression analysis showed that the extension duration of diabetes,increased BMI,combining with macro or micro vascular complication and gradual strengthening antidiabetic treatment were independent risk factors for HbA1c target （P 〈 0.05）.Conclusions Current status of HbA1c control in the middle aged and elderly patients with T2DM in Lanzhou communities is not optimistic,which is affected by many factors,suggesting that professional education on management should be further strengthened.And optimal treatment programs and individualized comprehensive treatment are needed for most patients to improve glycemic control.