2013年全国2型糖尿病患者人胰岛素治疗状况调查

Survey of glycemic control in type 2 diabetic patients treated with human insulin in China

目的了解我国正在应用人胰岛素治疗的糖尿病患者的糖化血红蛋白（HbA1c）达标状况，寻找目前糖尿病管理的问题。方法2013年4至7月在全国范围内348家三级甲等医院内分泌专科门诊选取目前正在接受人胰岛素单药或联合口服降糖药物治疗、符合入选标准的2型糖尿病患者，按照《数据采集标准操作流程（SOP）》询问患者，采用问卷形式收集、了解患者性别、年龄等一般信息、治疗、血糖控制、糖尿病病程、慢性并发症、血糖等情况，并填写至《监测网登记表》。以HbA1c〈7%为达标。两组间比较采用t检验。结果共入选75168例2型糖尿病患者，其中男性41199例，女性33969例，平均年龄（59±10）岁，入组时平均糖尿病病程为（8±5）年。起始人胰岛素治疗时的平均糖尿病病程为（4±4）年。79.83%的患者起始人胰岛素治疗的原因为口服降糖药物疗效不佳。人胰岛素平均用量为（30±11）U/d。在治疗方案中，餐时＋基础、餐时、基础和预混人胰岛素的构成比分别为7.37%、8.25%、6.71%和77.66%。调查人群的HbA1c达标率为31.84%。进行自我血糖监测与否、胰岛素剂量是否稳定、有无发生低血糖、有无发生严重低血糖、是否餐前等待30 min、是否健康饮食、有无体育锻炼、有无伴随疾病患者的HbA1c达标率差异均有统计学意义（χ^2=8.30～2056.59，均P〈0.05）结论口服药疗效不佳是起始人胰岛素治疗的主要原因，适时起始胰岛素治疗，对控制血糖有一定临床意义。调研人群中大部分患者血糖控制仍不满意，需要及时的进行治疗方案的优化。

Objective To assess the characteristics and glycemic control of type 2 diabetic patients currently treated with human insulin regimen in China, and find out the issues in diabetes management. Methods From April to July in 2013, type 2 diabetic outpatients on the therapy of human insulin or human insulin combined with oral antidiabetic drugs （OADs）, meeting the inclusion and exclusion criteria, were selected from the endocrinology departments of 348 representative hospitals across China, and filled out the information form. General information of the patients, duration of diabetes, medical history, diabetes complications and concomitant diseases, blood glucose and treatment regiment were recorded.The percentage of patients achieving glycated hemoglobin A1c（HbA1c） target 〈7.0% intergroup difference was compared with t test. Results A total of 75 168 eligible patients with type 2 diabetes were included in this study, 41 199 males and 33 969 females. The mean age was （59 ± 10） years. The mean duration of diabetes was （8 ± 5） years. The mean duration of diabetes before initiating human insulin was （4 ± 4）years. Of the patients, 79.83%started insulin therapy due to the poor glycemic control with oral hypoglycemic agents. The mean dose of human insulin was （30±11） U/day. The proportion of patients receiving basal-bolus, prandial, basal, and premixed insulin regimen was 7.37%, 8.25%, 6.71% and 77.66%, respectively. The total percentage of patients achieving HbA1c target was 31.84%. The rates of achieving HbA1c target between the patients with and without regular self-monitoring of blood glucose, insulin dosage was stable or not, with or without hypoglycemia, with or without svere hyperglycemia, waited 30 min for the meal after injection or not, developed healthy diet habits or not, with physical training or not, with or without concomitant diseases were all significantly different（χ^2=8.30-2056.59, all P〈0.05）. Conclusions Poor glycemic control with oral hypoglycemic agents is the main reason for insulin initiation. Timely initiating insulin may bring clinical benefit.