家族史、肥胖及自我管理行为在2型糖尿病患者糖化血红蛋白达标中的作用

Effects of family history,obesity and self-management behavior on hemoglobin A1c achievement in patients with type 2 diabetes mellitus

目的探讨家族史、肥胖及自我管理行为对中国基层2型糖尿病(type 2 diabetes mellitus,T2D)患者糖化血红蛋白(hemoglobin A1c,HbA1c)控制达标的作用。方法对2016年1月—2019年12月五家糖尿病专科连锁医院连续就诊且资料存储于院内糖尿病共同照护信息系统的门诊或住院T2D患者基线数据进行横断面分析,比较HbA1c是否达标(HbA1c<7.0%)两组的一般状况,采用多因素logistic回归分析对HbA1c未达标相关因素进行分析。结果共纳入8506例患者,HbA1c达标率27.75%,有家族史者2860例(33.62%),肥胖者1541例(18.12%)。HbA1c是否达标,两组在年龄、病程、体质量指数、吸烟、学历、饮食依从性、运动、遵嘱监测血糖、遵嘱用药及治疗方案方面的比较,差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,肥胖(OR=1.226,95%CI:1.042~1.441)和病程长(OR=1.019,95%CI:1.009~1.028)增加了HbA1c不达标的风险,单纯口服药治疗(OR=0.388,95%CI:0.345~0.436)、遵嘱用药(OR=0.805,95%CI:0.699~0.928)、规律运动(OR=0.886,95%CI:0.786~1.000)降低了HbA1c不达标的风险。结论本研究提示中国基层T2D患者HbA1c达标率低,治疗方案、遵嘱用药、规律运动及肥胖是HbA1c达标的相关因素。在临床糖尿病管理中需特别关注胰岛素治疗患者及肥胖患者,并关注患者在遵嘱用药及规律运动方面的依从性。

Objective To explore the effects of family history,obesity and diabetes self-management behavior(DSMB)on hemoglobin A1 c(HbA1c)control and achievement among patients with type 2 diabetes mellitus(T2D)in Chinese primary medical institutions.Methods A cross-sectional analysis was conducted in T2D outpatients or inpatients successively treated in5 diabetes specialized chain hospitals from January 2016 to December 2019,and their information was stored in the diabetes shared-care information system.HbA1c achievement(HbA1c<7.0%)or not and the general status were compared between the two groups.Multivariate logistic regression analysis was performed to identify factors related to HbA1c non-achievement.Results A total of 8,506 patients were enrolled in this study,with 27.75%of patients achieving HbA1c targets.There were 2,860(33.62%)cases with positive family history and 1,541(18.12%)cases with obesity.As for HbA1c achievement or not,statistically significant differences were found between the two groups in terms of age,diabetes duration,body mass index,smoking,education background,dietary adherence,physical exercise,adherence to blood glucose monitoring,medication compliance and therapeutic regimen(all P<0.05).Multivariate logistic regression analysis showed that obesity(OR=1.226,95%CI:1.042-1.441)and long duration(OR=1.019,95%CI:1.009-1.028)increased the risk of HbA1c non-achievement,while oral therapy alone(OR=0.388,95%CI:0.345-0.436),medication compliance(OR=0.805,95%CI:0.699-0.928)and regular exercise(OR=0.886,95%CI:0.786-1.000)decreased the risk of HbA1c non-achievement.Conclusion This study suggests that the achievement rate of HbA1c in T2D patients in Chinese primary medical institutions is low.Therapeutic regimen,medication compliance,regular exercise and obesity are factors related to HbA1c achievement.In clinical practice,special attention should be paid to patients treated with insulin or with obesity,and patients’compliance in medication and regular exercise.