上海某社区老年2型糖尿病患者糖化血红蛋白控制情况及影响因素分析

Control status of glycosylated hemoglobin and its influencing factors in elderly patients with type 2 diabetes mellitus in a Shanghai community

目的调查上海市某社区老年2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)的控制现状及其影响因素,为优化血糖控制措施提供理论指导依据。方法采用单纯随机抽样选取上海市浦东新区潍坊社区老年T2DM患者为研究对象,进行面对面问卷调查、体格检查以及实验室检测。采用SAS 9.4软件进行χ^(2)检验、秩和检验和多因素Logistic回归分析。结果本横断面研究共调查老年T2DM患者594例,其中HbA1c达标308例(51.8%)。男性和女性血糖控制率分别48.7%和54.5%,差异无统计学意义(χ^(2)=1.96,P>0.05)。单因素分析结果显示,文化程度、家庭人均收入、居住情况、自感血糖控制满意度、糖尿病病程、血脂异常、肾脏疾病、遵医嘱运动、遵医嘱饮食、遵医嘱服药、治疗模式、空腹血糖、尿葡萄糖、尿蛋白、尿酮体和甘油三酯共16个影响因素的血糖控制率差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,高家庭人均月收入(OR=0.572,95%CI:0.358~0.913)、遵医嘱运动(OR=0.631,95%CI:0.435~0.917)、遵医嘱饮食(OR=0.592,95%CI:0.391~0.897)和遵医嘱服药(OR=0.661,95%CI:0.442~0.989)是老年T2DM患者血糖达标的保护因素,而高龄(OR=1.347,95%CI:1.019~1.781)、糖尿病病程长(OR=1.610,95%CI:1.268~2.044)和血脂异常(OR=2.183,95%CI:1.529~3.118)是老年T2DM患者血糖达标的危险因素,且均有统计学意义(P均<0.05)。结论社区老年T2DM患者HbA1c控制达标率有待提高,受多种因素共同影响,建议针对这些因素采取有效的干预措施以提高老年T2DM患者血糖控制达标率。

Objective To investigate the current control status of HbA1c and its influencing factors in elderly patients with type 2 diabetes mellitus(T2DM)in Weifang Community of Pudong New Area of Shanghai,and to provide theoretical guidance for optimizing glycemic control measures.Methods A total of 594 elderly T2DM patients in Weifang Community of Pudong New Area of Shanghai were selected by simple random sampling as the research objects,and face-to-face questionnaires,physical examinations and laboratory tests were conducted.SAS9.4 software was used forχ^(2) test,rank sum test and multivariate Logistic regression analysis.Results Among the 594 elderly T2DM patients in this cross-sectional study,308 cases(51.8%)achieved the HbA1c standard.The glycemic control rate of male and female was 48.70%and 54.5%,respectively,and the difference was not statistically significant(P>0.05).The univariate analysis showed the differences in the effect on glycemic control rate for all the 16 influencing factors,including degree of education,average family income,living situation,self-satisfaction of glycemic control,duration of T2DM,dyslipidemia,kidney disease,exercise as prescribed,diet as prescribed,taking medicine as prescribed,treatment mode,fasting blood-glucose,urine glucose,urine protein,urine acetone bodies and triglyceride were statistically significant(χ^(2)=1.96,P<0.05).The multivariate Logistic regression analysis displayed that high average family income(OR=0.572,95%CI:0.358~0.913),exercising as prescribed(OR=0.631,95%CI:0.435~0.917),diet as prescribed(OR=0.592,95%CI:0.391~0.897)and taking medicine as prescribed(OR=0.661,95%CI:0.442~0.989)were the pro-tective factors for good glycemic control in elderly T2DM patients.In contrast,older age(OR=1.347,95%CI:1.019~1.781),long duration of T2DM(OR=1.610,95%CI:1.268~2.044)and dyslipidemia(OR=2.183,95%CI:1.529~3.118)were the risk factors for good glycemic control in elderly T2DM patients(P<0.05).Conclusion The HbA1c control in elderly T2DM patients in the community needs to be further improved,which is affected by multiple fac-tors.It is recommended to take effective intervention measures to improve the glycemic control rate of elderly T2DM patients.