淮安市城区糖尿病合并高血压患者血糖控制情况及影响因素分析

Analysis on the status and influencing factors of glycemic control in type 2 diabetic patients with hypertension in urban areas of Huai＇an

目的：了解淮安市城区2型糖尿病合并高血压患者临床指标特征，分析其血糖控制的影响因素。方法于2014年，采取两阶段整群随机抽样方法，在淮安市城区抽取5个社区，对登记管理的2型糖尿病患者开展问卷调查、临床查体和生化检查，比较1065例糖尿病合并高血压患者和922例糖尿病正常血压患者相关信息和临床指标异同，并采用多因素非条件logistic回归分析影响血糖控制的因素。结果糖尿病合并高血压患者和糖尿病正常血压患者血糖控制达标（HbA1c〈7.0%）人数分别为419例（39.3%）和480例（52.1%）。糖尿病合并高血压患者的体质指数、糖尿病病程和血清肌酐均值均高于糖尿病正常血压患者，差异均有统计学意义（P〈0.05）。糖尿病合并高血压患者的大血管并发症（32.4%）和血脂异常比例（71.9%）均高于糖尿病正常血压患者（18.5%、66.9%），差异均有统计学意义（P〈0.05）。多因素logistic回归分析发现，文化程度高、家庭年均总收入高、经常监测血糖有利于糖尿病合并高血压患者血糖控制，而年龄大、血压高、腰臀比大、三酰甘油和血清肌酐升高不利于血糖控制。结论淮安市城区2型糖尿病合并高血压患者的血糖控制仍不理想，应重点加强社区老年糖尿病患者中心性肥胖、三酰甘油升高等危险因素的管理。

Objective To explore the clinical features of type 2 diabetic patients with hypertension , and to analyze the influencing factors of glycemic control. Methods Using stratified cluster random sampling method, 5 communities were selected from urban areas of Huai＇an in 2014. Type 2 diabetic patients managed by the communities were surveyed with questionnaire, physical and biochemical examinations. The related information and clinical features were compared between diabetic patients with and without hypertension. Logistic regression analysis was used to analyze the influencing factors of glycemic control. Results The number of well-controlled diabetic patients （HbA1c〈7.0%） with and without hypertension （HbA1c〈7.0%） were 419 （39.3%） and 480 （52.1%）, respectively. Mean values of body mass index （BMI）, diabetic duration and serum creatinine in diabetic patients with hypertension were significantly higher than those in diabetic patients without hypertension （P〈0.05）. The proportions of macrovascular complications and dyslipidemia in diabetic patients with hypertension were significantly higher than diabetic patients without hypertension （P〈0.05）. Multiple logistic regression analysis showed that high degree of education, high annual family income and high frequency of glucose monitoring were beneficial factors for glycemic control in diabetic patients with hypertension. Older age, hypertension, higher waist to hip ratio （WHR）, the elevated triglyceride and serum creatinine were harmful factors for glycemic control. Conclusions The situation of glycemic control in diabetic patients with hypertension in urban areas of Huai＇an is not optimistic. Therefore, community managements of risk factors such as central obesity and increased triglyceride in elder diabetic patients should be strengthened.