不同降糖方案对2型糖尿病患者依从性及HbA1c达标率的影响

Effect of different treatment on the compliance and HbA1c compliance rate in patients with type 2 diabetes mellitus

目的比较不同降糖方案对2型糖尿病(T2DM)患者依从性及糖化血红蛋白(HbA1c)达标率的影响。方法回顾性分析我院2017年6月~2018年9月门诊随访的120例T2DM患者资料,依据不同的治疗方法分为A组(单纯口服药物)、B组(磺脲类促泌剂+二甲双胍+预混胰岛素30 R晚餐前注射1次)、C组(磺脲类促泌剂+二甲双胍+甘精胰岛素晚餐注射1次)、D组(二甲双胍+预混胰岛素30 R早晚餐前各注射1次),每组各30例。回顾性分析近3个月的四组的血糖控制情况,期间可调整药物剂量,不更改用药方案,比较其血糖达标率及依从性,并分析依从性的影响因素。结果四组依从性比较,差异无统计学意义(χ2=1.445,P=0.963),血糖达标率比较,差异无统计学意义(χ2=0.372,P=0.946),再把各组按依从性好及不依从的患者分为两组,依从性好组HbA1c达标率明显高于依从性差组(t=11.012,P=0.000);单因素分析结果提示,患者受教育程度、经济状况及是否参加医保均影响患者的依从性(P=0.000)。应用Logistic回归分析结果提示,患者受教育程度、经济状况及是否参加医保,为依从性独立影响因素。结论四组治疗方案中依从性相似,糖化血红蛋白达标率相似,但这并不能说明该四种降糖方案效果相似,而应根据患者的个体差异选择不同的降糖方案;另外,在治疗方案恰当的情况下,依从性高的患者HbA1c达标率明显高于依从性低的患者;强化健康宣教、提高全民经济水平、全面推行门诊医疗保险制度可提高患者的依从性,从而优化治疗效果。

Objective To compare the effect of different treatment on compliance and glycosylated hemoglobin A1c(HbA1c)compliance rate in patients with type 2 diabetes mellitus(T2DM).Methods The outpatient data of 120 patients with T2DM who followed up from June 2017 to September 2018 in our hospital were retrospectively analyzed.According to different the treatment methods,they were divided into group A(oral Hypoglycemic drugs only),group B(Sulfonylurea secretagogue+metformin+premixed insulin 30 R injection before supper),group C(Sulfonylurea secretagogue+metformin+insulin glargine injection once in the evening),and group D(Metformin+premixed insulin 30 R was injected twice before breakfast and dinner),30 cases in each group.The control of blood sugar in recent three months was retrospectively analyzed.During the period,the dosage of drugs could be adjusted without changing the medication plan.The blood sugar compliance rate and compliance were compared,and analyze the influencing factors of compliance.Results There was no statistical difference in compliance(χ2=1.445,P=0.963)and blood sugar compliance rate(χ2=0.372,P=0.946)among the four groups.The patients in each group were divided into two groups according to their good compliance and poor compliance.The compliance rate of HbA1c in the good compliance group was significantly higher than that in the poor compliance group(t=11.012,P=0.000).Univariate analysis showed that education level,economic status and participation in health insurance affected the patient′s compliance(P=0.000).Logistic regression analysis showed that education level,economic status and medical insurance were the independent influencing factors of the compliance.Conclusion Compliance and HbA1c compliance rate are similar in the four groups,but it does not mean that the four hypoglycemic schemes have similar effect,but different hypoglycemic schemes should be selected according to individual differences of patients.In addition,in the case of appropriate treatment,the compliance rate of HbA1c in patients with high compliance was significantly higher than that in patients with low compliance;so,strengthening health education,improving the economic level of the whole people and implementing the outpatient medical insurance system in an all-round way can improve the compliance of patients and optimize the treatment effect.