南京地区40岁以上人群2型糖尿病控制现状的调查分析

The current management situation of type 2 diabetes mellitus patients over 40 years old in Nanjing

目的 了解南京地区40岁以上人群的糖尿病发病现状,以及当前医疗模式下的干预对糖尿病自然人群血糖和其他代谢指标的实际影响.方法 于2011年6-11月,对南京市栖霞区40～79岁常住居民进行流行病学调查,总调查人数为10 300人,筛查出糖尿病患者2 293例.其中,既往诊治的糖尿病患者1 393例,新诊断糖尿病而未行干预的患者900例,采用多因素Logistic回归比较此2组患者的糖化血红蛋白(HbA1c)、血压、LDL-C水平的差异性.结果 南京地区40岁以上人群糖尿病患病率高达23.28％(2 293/9 850).混杂因素校正后,40～50岁患者中,既往诊治糖尿病患者的HbA1c达标率是新诊断糖尿病患者的3倍,而血压和LDL-C无明显差异;51～60岁患者是否已诊治糖尿病对HbA1c、血压及LDL-C均无显著影响;而61 ～ 79岁既往诊治患者的HbA1c达标率明显低于新诊断糖尿病者(61～70岁:0R=0.649,95％CI 0.487～0.865;71～79岁:OR=0.474,95％CI0.333～0.674).结论 当前国内糖尿病管理模式并未使高龄患者受益,其管理模式有待改进.糖尿病患者整体血糖达标率低下的主要瓶颈在于50岁以上糖尿病患者的血糖达标率过低,尤其是60岁以上高龄患者.为提高糖尿病患者的血糖达标率,今后的工作重点应为50岁以上糖尿病患者,尤其是60岁以上患者.

Objective To explore the current situation of type 2 diabetes mellitus (T2DM) patients over 40 years old management in Nanjing.Methods A cross-sectional,community-based study was conducted in Nanjing from June to November,2011.Among 10 300 Chinese aged 40-79 years,1 393 preexisting T2DM and 900 newly diagnosed T2DM cases met eligibility criteria for enrollment.The level of HbA1c,blood pressure and LDL-C were compared.Results The prevalence of T2DM among Nanjing residents was 23.28％ (2 293/9 850).The HbA1c-target-rate of pre-existing T2DM patients with ages from 40 to 50 years was three times of newly diagnosed T2DM patients with the same age group,while there were no significant differences of blood pressure and LDL-C between the two groups.In 51-60 years age group,there were no significant differences of HbA1c,blood pressure and LDL-C between pre-existing T2DM and newly diagnosed T2DM patients (OR=0.649,95％CI was 0.487-0.865).In 61-79 years age group,patients with pre-existing T2DM had higher risk of elevated HbA1c level compared with those with newly diagnosed T2DM (OR=0.474,95％CI was 0.333-0.674).Conclusions Elder diabetics are less benefited from current managements of diabetes.The major challenge might be the low glucose-target-rate among the patients over 50 years old.In future,to greatly elevate the glucose-target-rate,we should address the improvement of diabetes management among the diabetics over 50 years old,especially among the patients over 60 years old.