南京市社区2型糖尿病患者代谢指标达标和微血管并发症患病现况及影响因素分析

Current metabolic control status and microvascular complications and their influencing factors among type 2 diabetes mellitus in Nanjing communities

目的调查南京市社区T2DM患者血糖、血压、血脂达标及微血管并发症患病现况并分析其影响因素。方法选取2016年11月至2017年6月南京市10家社区卫生服务中心1956例T2DM患者,评估血糖、血压、血脂达标及DKD、糖尿病周围神经病变(DPN)现况。结果纳入患者的血糖、血压、血脂达标率分别为42.2%、31.4%、39.4%,三者均达标的为5.7%,合并DKD、DPN的为44.1%、50.4%。糖尿病病程≥5年、BMI≥24 kg/m^2和腹型肥胖患者血糖达标率低。多因素Logistic回归分析显示,腹型肥胖(OR 1.340,95%CI 1.050~1.710,P=0.018)、糖尿病病程5~10年(OR1.970,95%CI 1.540~2.510,P<0.01)、糖尿病病程≥10年(OR 3.110,95%CI 2.430~3.990,P<0.01)是血糖不达标的危险因素;女性、年龄≥65岁、BMI≥28 kg/m^2、糖尿病病程≥10年、血压、血糖不达标是DKD的危险因素;年龄≥65岁是DPN的危险因素。结论南京市社区T2DM患者血糖、血压、血脂综合控制达标率有待提高,糖尿病微血管并发症需加强管理。

Objective To investigate the control of blood glucose,blood pressure and blood lipids and the prevalence of microvascular complications among patients with type 2 diabetes mellitus(T2DM)in Nanjing communities and further to analyze their influencing factors.Methods From November 2016 to June 2017,a total of 1956 T2DM patients from 10 community clinics in Nanjing were enrolled.The primary clinical measurement were the levels of HbA1 c,blood pressure and blood lipid in reference to target goals.Diabetic kidney disease(DKD)and diabetic peripheral neuropathy(DPN)were screened in all patients.Results 42.2%,31.4% and 39.4% of patients achieved the individual target goals for the control of blood glucose,blood pressure and blood lipid respectively and only 5.7% of the patients achieved all 3 target goals.44.1% and 50.4% of patients combined with DKD and DPN,respectively.Patients with diabetes duration≥5 years,body mass index(BMI)≥24 kg/m^2 and abdominal obesity had poor glycemic control.Multivariate regression analysis showed that abdominal obesity(OR 1.340,95%CI 1.050~1.710,P=0.018)and longer diabetic duration(OR 1.970,95%CI 1.540~2.510,duration 5~10 years;OR 3.110,95%CI 2.430~3.990,duration≥10 years)were risk factors of not achieving glycemic target.Female,age≥65 years,BMI≥28 kg/m^2,diabetes duration≥10 years,uncontrolled blood pressure and uncontrolled blood glucose were independent risk factors of DKD.Age≥65 years is an independent risk factor of DPN.Conclusion The control of blood glucose,blood pressure and blood lipid among T2DM patients in communities needs to be improved.The management of diabetic microvascular complications needs to be enhanced.