江苏省2型糖尿病患者药物治疗方法与血糖控制关系

Relationship between glycemic control and medication treatment in patients with type 2 diabetes mellitus in Jiangsu province

目的了解江苏省2型糖尿病(T2DM)患者药物治疗方法与血糖控制的关系,为T2DM的预防控制提供参考依据。方法于2013年12月—2014年1月,采用整群随机抽样方法在江苏省常熟市和淮安市淮安区、清河区抽取纳入基本公共卫生服务且采取药物治疗措施的15 037例T2DM患者进行问卷调查、体格检查和实验室检测。结果江苏省15 037例T2DM患者中,单用口服药治疗者12 318例(81.9%),单用胰岛素治疗者1 728例(11.5%),口服药联合胰岛素治疗者991例(6.6%);不同特征T2DM患者药物治疗方法比较,不同性别、文化程度、婚姻状况、地区、居住地、吸烟、饮酒、糖尿病病程、体质指数(BMI)及有无中心性肥胖、高血脂、糖尿病并发症、糖尿病家族史的T2DM患者药物治疗方法差异均有统计学意义(均P<0.01);江苏省T2DM患者血糖控制达标率为32.5%,单用口服药治疗者、单用胰岛素治疗者和口服药联合胰岛素治疗者血糖控制达标率分别为34.7%、25.3%和17.7%;在调整了性别、年龄、文化程度、婚姻状况、地区、居住地、吸烟、饮酒、糖尿病病程、BM I及有无中心性肥胖、高血压、高血脂、糖尿病并发症、糖尿病家族史等混杂因素后,多因素非条件logistic回归分析结果显示,单用胰岛素治疗者和口服药联合胰岛素治疗者血糖控制达标率分别为单用口服药治疗者的0.679倍(OR=0.679,95%CI=0.599~0.770)和0.465倍(OR=0.465,95%CI=0.388~0.558)。结论江苏省T2DM患者的药物治疗率较高,但血糖控制达标率较低,单用口服药治疗者的血糖控制达标率较高。

Objective To assess the relationship between medication treatment and glycemic control in patients with type 2 diabetes mellitus （T2DM） in Jiangsu province and to provide evidences for the control of T2DM. Methods We conducted a cross-sectional survey with stratified cluster sampling in Changshu city and Huai＇an and Qinghe district of Huaian city in Jiangsu province between December 2013 and January,2014. Totally 15 037 T2DM patients who were reg- istered in the National Basic Public Health Service and administered with drug therapy were recruited in the three regions and all the patients received a questionnaire interview, laboratory tests and physical examinations. Results Of the 15 037 patients, 12 318 （ 81.9 % ） took single oral hypoglycemic agent; 1 728 （ 11.5 % ） took single insulin; and 991 （ 6. 6 % ） adopted oral hypoglycemic agents plus insulin. The drug therapy for T2DM differed significantly by gender, education level,marital status, living region, residential address, smoking, alcohol drinking, course of T2DM, body mass index （BMI）, and whether having central obesity, hyperlipidemia, diabetic complication, and family history of diabetes among the patients （P 〈 0. 01 for all）. The proportion of the patients with the glycated hemoglobin Alc （HbAlc） reaching the national control standard was 32. 5% and the proportion of glycemic control reaching the national control standard was 34. 7% ,25.4% ,and 17.7% for the patients administered with single oral hypoglycemic agent, single insulin, and oral hypoglycemic agents plus insulin, respectively. The results of multivariate unconditional logistic regression analysis showed that the glycemic control rate for the patients taking single insulin and oral medication combined with insulin was 0. 679 time （95% confidence interva[95% CI] ：0. 599 -0. 770） and 0. 465 time （95% CI：O. 388 -0. 558） lower than those taking single oral hypoglycemic agent after adjusting for all the potential confounders mentioned above. Conclusion The rate of medication treatment is high among T2DM patients in Jiangsu province, especially among the patients with single oral hypoglycemic agent, but the rate of glycemic control is still low.