上海市普陀区社区管理2型糖尿病患者心血管病危险因素的控制状况

Control of risk factors for cardiovascular disease in patients with type 2 diabetes in community of Putuo District of Shanghai

【目的】了解上海市普陀区社区管理2型糖尿病(T2DM)患者血糖及心血管疾病危险因素。【方法】采用系统抽样方法,抽取上海市普陀区10个社区在册管理的408例T2DM患者进行问卷调查、体格检查及实验室检测,收集人口学信息及血糖、血脂、血压控制情况并进行分析。【结果】共纳入408例T2DM患者,其中男性186例(45.59%),女性222例(54.41%),平均年龄为(66.86±6.97)岁。合并高血压者占61.27%,合并血脂异常者占60.05%,超重或肥胖者占56.62%。平均糖化血红蛋白(Hb A1c)为(7.43±1.52)%。血糖(Hb A1c<7%)、血压(<140/80 mm Hg)、血脂达标(LDL-C<2.6 mmol/L)的患者分别为48.77%、26.23%和26.72%,只有2.70%的患者Hb A1c、血压、LDL-C同时达标。T2DM病程大于10年者,Hb A1c达标率最低(P<0.01)。多因素logistic回归分析显示,影响血糖达标的独立因素分别为吸烟、病程长、BMI高,影响血压达标的独立因素为睡眠时间≥7 h/d、超重/肥胖、腰臀比(WHR)高,影响血脂达标的独立因素为女性、腰围大。【结论】普陀区社区管理T2DM患者中,血糖、血压、血脂综合防治达标率不尽如人意,应加强对社区2型糖尿病患者心血管疾病危险因素的综合控制。

[Objective] To ascertain the control of blood glucose and risk factors for cardiovascular disease in communities of Putuo District of Shanghai. [Methods]A cross sectional study was conducted among 408 registered patients with type 2 diabetes mellitus（ T2 DM） from 10 communities of a district through a systematic sampling method. Data on demographic information, blood glucose, blood pressure, blood lipids levels were collected by questionnaire interviews, physical examinations, and laboratory tests.[Results]A total of 408 T2 DM patients were enrolled,including 186 males（ 45. 59%） and 222 females（ 54. 41%）. The average age of the participants were（ 66. 86 ± 6. 97） yrs. Those with hypertension accounted for 61. 27%,with dyslipidemia 60. 05%,and with obesity or overweight 56. 62%. Their mean Hb A1 c level was（ 7. 43 ± 1. 52） %. While 48. 77%,26. 23%,and 26. 72% of the patients achieved the individual target goals for control of blood glucose（ Hb A1 〈c7%）,blood pressure（ systolic blood pressure〈140 mm Hg, diastolic blood pressure 80 mm Hg）, and blood lipids（ LDL-C 〈2. 6 mmol/L）,respectively,only 2. 70% of them achieved all 3-target goals. The control rate of Hb A1 c was significantly the lowest in the group of disease duration more than 10 years（ P〈0. 01）. Multivariable logistic regression analysis showed that the factors influencing blood glucose were smoking,long duration of disease and high BMI; the factors influencing blood pressure were sleep time ≥ 7 h/d,overweight and high WHR; the factors influencing blood lipids were female sex,and big waist size. [Conclusion]The control of diabetes,hypertension,dyslipidemia in type 2 diabetes patients in communities of Putuo District of Shanghai has been（ was） unsatisfactory. Achieving adequate control of risk factors for cardiovascular disease in patients with type 2 diabetes remains a challenge. The intervention should be strengthened for type 2 diabetes complications in communities.