2型糖尿病患者用药模式与血糖控制情况

Medication pattern of anti-diabetic therapy and glycemic control in patients with type 2 diabetes mellitus of Tianjin

目的 了解天津地区不同等级医院就诊的2型糖尿病（T2DM）患者的用药现状,评价不同用药方案T2DM患者血糖控制情况,分析相关影响因素。方法 2012年3-6月在天津市不同等级47所医院建立糖化监测网,以统一的调查问卷收集了16 631例年龄≥18岁,正在接受口服降糖药或联合其他药物治疗的T2DM患者的基本信息、临床检查资料及实验室检测资料。所有数据均使用SPSS 19.0软件进行统计学处理,血糖达标的影响因素分析采用非条件logistic回归分析。结果 最终纳入分析的T2DM患者16 507例,其中男性8 282例,女性8 225例,平均年龄（59.0±11.3）岁,病程为5（2～9）年。按照糖化血红蛋白（Hb A1C）〈7.0%计算达标率时,总体达标率为36.9%,各种用药模式的达标率依次为单用口服药组（49.9%）、联合用药组（33.7%）、单用胰岛素组（14.2%）;按照Hb A1C〈6.5%计算达标率时,总体达标率为15.6%,各种用药模式依次为单用口服药组（22.4%）、联合用药组（12.6%）、单用胰岛素组（5.7%）。除了单用胰岛素组,其他2种用药模式下,患者血糖控制达标率均随病程的延长呈降低趋势（P〈0.01）。logistic回归分析结果显示,年龄大、男性、糖尿病病程长、未进行自我血糖检测、体质指数低、收缩压高、低密度脂蛋白胆固醇水平高、单用胰岛素治疗的患者血糖控制更不易达标。结论 天津市T2DM患者的Hb A1C达标率总体偏低,其中,单用胰岛素治疗的患者血糖、血压、血脂控制情况均最差,提示这部分患者应合理调整用药模式,定时监测血糖,以减少并发症的发生。

Objective To assess the medication pattern of anti-diabetic therapy and glyeemie control in adult subjects with type 2 diabetesmellitus （T2DM） of Tianjin and to anatyze the related influeneing faetors. Methods Aglyeosylatedmonitoringnetwork of 47 hospitals in Tianjin was established during March to June in 2012, the questionnaires were used to select 16 631 subjects （ 1〉 18 years old） with T2DM, the subjects were treated with oral anti-diabetes drugs （OADs） or OADs plus other medications. General, clinical and laboratorial data of all subjects were collected. SPSS 19.0 software was used to analyze all data, the influencing factors of glyeemie control were analyzed with unconditional logistic regression analysis. Results A total of 16 507 （8 282 males and 8 225 females, average age 59 years old, mean diabetes duration 5 years） eligible T2DM patients were enrolled in this study. According to HbAm〈7.0% as the standard, total reach standard rate, the reach standard rates of OADs, OADs plus other medications and only insulin groups were 36.9%, 49.9%, 33.7% and 14.2%, respectively. According to HbAm〈6.5% as the standard, total reach standard rate, the reach standard rates of OADs, OADs plus other medications and only insulin groups were 15.6%, 22.4%, 12.6% and 5.7%, respectively. The reach standard rates of OADs group and OADs plus other medications group reduced significantly with the disease duration （P〈0.01）. Logistic regression analysis showed that it was not easy to reach the standard of glyeemie control for T2DM patients with elderly, male, longer diabetes duration, higher SBP, higher LDL-C, less BMI, non- self-monitoring blood glucose and only using insulin. Conclusion According to HbAlc as the standard, the reach standard rate in T2DM patients of Tianjin was low. The glyeemie, blood pressure and blood lipid control in T2DM patients only using insulin was low, it was suggested that those patients should reasonably adjust the anti-diabetic medication pattern and regularly monitor the blood glucose for reducing complication.