2017年昆山社区管理糖尿病患者血糖控制效果评价

Evaluation on the effect of blood sugar control in community-managed diabetic patients in Kunshancity in 2017

目的了解2017年昆山市基本公共卫生服务中社区糖尿病患者血糖控制模式及其控制效果。方法采用整群随机抽样方法,抽取2017年某社区至少随访管理1次的糖尿病患者2 537例,分析血糖控制模式与控制效果在诸因素之间的分布;采用多因素logistic回归分析血糖未控制的影响因素。结果糖尿病患者中血糖未控制率为50.6%,血糖控制模式中,不用药、单用口服降糖药、单用胰岛素、联合口服降糖药和胰岛素4种模式,分别占16.3%、70.1%、5.3%、8.3%,对应的血糖未控制率分别为33.3%、52.6%、57.8%、63.0%。多因素分析显示,肥胖(OR=1.03,95%CI:1.00~1.05)、随访频率>4次(OR=1.32,95%CI:1.13~1.54)、纳入管理时血糖偏高(OR=1.67,95%CI:1.38~2.02)、2017年签约家庭医生(OR=1.26,95%CI:1.07~1.49)、随访收缩压高(OR=1.87,95%CI:1.55~2.27)、糖尿病病程>10年(OR=1.45,95%CI:1.18~1.78)与糖尿病患者血糖未控制存在统计学关联。结论2017年昆山社区卫生服务机构管理的糖尿病患者血糖未控制率较高;基于基本公共卫生服务的2型糖尿病患者健康管理尚需进一步加强。

Objective To examine the treatment pattern and effect of glycemic control of type 2 diabetic patients managed by community health centers in Kunshan city,2017.Methods A cluster random sampling method was conducted to obtain the 2537 type 2 diabetes patients,who were followed up at least once in 2017 by one community in Kunshan city.The distribution of diabetes treatment pattern and glycemic control rate among demographics and other variables were analyzed,multivariate logistic regression analysis was used to identify factors associated with glycemic uncontrolled rate.Results The glycemic uncontrolled rate among diabetic patients was 50.6%.Treatment pattern of non-medication,oral anti-diabetes drugs,insulin,combined oral anti-diabetes drugs and insulin accounted for 16.3%,70.1%,5.3%and 8.3%,respectively;the corresponding glycemic uncontrolled rates were 33.3%,52.6%,57.8%and 63.0%,respectively.Multivariate logistic regression analysis demonstrated that obese(OR=1.03,95%CI:1.00-1.05),follow up more that 4 times(OR=1.32,95%CI:1.13-1.54),hyperglycemia at initial administration(OR=1.67,95%CI:1.38-2.02),signed family doctor in 2017(OR=1.26,95%CI:1.07-1.49),hyper-systolic pressure(OR=1.87,95%CI:1.55-2.27)and duration of diabetes more that 10 years(OR=1.45,95%CI:1.18-1.78)were statistically correlated with glycemic uncontrolled rate.Conclusion The glycemic uncontrolled rate among community type 2 diabetes patients were relatively high in Kunshan city in 2017.The health management for type 2 diabetes based on essential public health services in community should be further strengthened.