中国35岁及以上糖尿病患者社区管理现状

The management status of diabetes patients (≥35 years old) in communities of China

目的了解我国≥35岁糖尿病患者社区管理现状和血糖控制情况,为糖尿病患者管理提供理论依据。方法数据来源于2015年中国成人慢性病与营养监测,选取其中≥35岁的糖尿病患者作为调查对象,收集调查对象的一般人口学特征、参加社区糖尿病管理以及糖尿病治疗的情况。所有调查对象均抽取空腹静脉血并检测空腹血糖。采用SAS 9.4软件进行基于复杂抽样的Rao Scottχ^(2)检验,比较不同性别、地区以及城乡之间率的差异,利用基于复杂抽样的logistic模型检验率随年龄的变化趋势。所有统计结果均为经过复杂加权调整后的数值。结果共纳入8 109名调查对象,男性3 560人,女性4 549人。糖尿病患者管理率为47.9%,城市为43.3%,农村为56.0%,农村糖尿病患者管理率高于城市,差异有统计学意义(χ^(2)=24.162,P<0.01)。糖尿病患者管理率随年龄的升高而升高,上升趋势有统计学意义(Waldχ^(2)=26.183,P<0.01)。纳入社区健康管理的糖尿病患者中,规范管理率为40.1%,其中城市为42.5%,农村为36.8%,城市明显高于农村,差异有统计学意义(χ^(2)=4.105,P<0.05)。经过复杂加权后,纳入社区管理的≥35岁糖尿病患者治疗率为95.5%(95%CI:94.4%~96.7%),血糖控制率为37.7%(95%CI:35.3%~40.1%)。≥65岁组控制率最高,血糖控制率随着年龄的增加而升高,趋势有统计学意义(Waldχ^(2)=5.959,P<0.05)。结论我国糖尿病规范管理率有了较大提高,但血糖控制率依然较低。应该进一步完善不同区域的医疗卫生资源配置,并且提高患者的依从性。

Objective To investigate the current situation of community-based management and blood glucose control of diabetes patients (≥35 years old) in China,and to provide the theoretical basis for the management of diabetes patients. Methods Data were from the China Chronic Diseases and Nutrition Surveillance of adults in 2015(CCDNS),the diabetes patients (≥35 years old) were selected as the subjects,the general demography characteristics,diabetes management of community and diabetes treatment of subjects were collected. The vein blood of each subject was drawn for test of fasting plasma glucose. The complex sampling Rao Scott χ^(2) test was used to compare the differences between different gender,areas and urban or rural areas,the complex sampling logistic model was used to test rate trend with age. All statistical results should be complex weighted adjusted.The used software was SAS 9.4. Results A total of 8 109 subjects(3 560 male cases,4 549 female cases) were included. The management rate of diabetes patients was 47.9%. The management rate(56.0%) in rural area was significantly higher than that(43.3%) in urban area(P<0.01). The management rate of diabetes patients increased with age(P<0.01). In diabetes patients included into health management of communities,the regular management rate was 40.1%,the regular management rate(42.5%)in urban area was significantly higher than that(36.8%) in rural area(P<0.05). After complex weighting,the treatment rate of diabetes patients (≥35 years old) included into management of communities was 95.5%(95%CI:94.4%-96.7%). The control rate of blood glucose was 37.7%(95%CI:35.3%-40.1%). The control rate of blood glucose in ≥65 years old group was the highest,and the control rate of blood glucose increased with age(P<0.05). Conclusion The regular management rate of diabetes has been greatly improved,but the blood glucose control rate is still lower. The allocation of health resources in different regions should be further improved and the patient compliance should be improved.