常熟市2型糖尿病患者血糖控制影响因素分析

目的 了解常熟市2型糖尿病(T2DM)患者血糖控制情况,初步探索患者血糖控制的影响因素,为采取有效干预措施提供参考依据。 方法 调查时间为2013年10月-2014年2月,采用多阶段分层整群抽样的方法,对常熟市纳入基本公共卫生服务的2型糖尿病患者10 246人进行糖尿病问卷调查、糖尿病患者身体测量和空腹血糖、糖化血红蛋白(HbA1c)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)的实验室指标检测。以HbA1c是否达标作为因变量,进行非条件logistic回归分析,将单因素非条件logistic回归分析中P<0.1的影响因素纳入多因素分析,用逐步回归法进行多因素非条件logistic回归分析,探讨血糖控制的影响因素。 结果 获得10 238名2型糖尿病患者的完整数据,常熟市2型糖尿病患者糖化血红蛋白(HbA1c)平均值为(7.6±1.6)%,控制未达标者(HbA1c≥7%)占59.2%。单因素非条件logistic回归分析结果显示性别、地区、文化程度、BMI、腰围、血脂、吸烟、饮酒对HbAlc的影响有统计学意义( P<0.01),多因素非条件logistic回归分析结果显示,地区(农村/城市OR=1.359,95%CI:1.252～1.475, P<0.001)、吸烟(OR=1.474,95%CI:1.327～1.638, P<0.001)、血脂异常(OR=1.240,95%CI:1.143～1.346, P<0.001)、腰围(中心性肥胖OR=1.294,95%CI:1.192～1.405, P<0.001)、文化程度(以未接受正规教育为参照,小学OR=0.825,95%CI:0.741～0.920, P<0.001;初中及以上OR=0.895,95%CI:0.808～0.991, P<0.001)是血糖控制的独立影响因素。 结论 常熟市2型糖尿病患者血糖控制情况不佳,血糖控制状况受地区、吸烟、血脂异常、中心性肥胖和文化程度的影响,应积极开展综合措施控制血糖和糖尿病并发症的发生。

Influencing factors of glycemic control in patients with type 2 diabetes mellitus in Changshu City

Objective To investigate the control status of patients with type 2 diabetes mellitus (T2DM) in Changshu City and to preliminarily explore the influencing factors of blood glucose control among the patients, so as to provide references for adopting effective countermeasures. Methods A questionnaire survey on diabetes mellitus was conducted among 10,246 T2DM patients selected by multi-stage cluster sampling method from those covered by basic public health services in Changshu City from October 2013 to February 2014. Physical and biochemical examinations including fasting blood glucose, hemoglobin A1C (HbA1c), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were performed. Unconditional logistic regression analysis was performed with HbA1c as the dependent variable. The influencing factors with P<0.1 in the single factor unconditional logistic regression analysis was included into the multi-factor analysis, and stepwise regression method was used to perform multi-factor unconditional logistic regression analysis to explore the factors influencing blood glucose. Results The complete data about 10,238 T2DM patients were obtained. The mean HbA1c concentration of the patients was (7.6±1.6)%, and 59.2% of the patients had HbA1c ≥7.00％. The single factor unconditional logistic regression analysis showed that gender, age, residence, education background, BMI, waistline, serum lipid, smoking and drinking significantly influnced the HbAlc level (P<0.01). The multi-factor unconditional logistic regression analysis showed that residence (countryside/city OR=1.359,95%CI:1.252~1.475, P<0.001), smoking(OR=1.474,95%CI:1.327~1.638, P<0.001), dyslipidemia(OR=1.240,95%CI:1.143~1.346, P<0.001), waist (central obesity OR=1.294, 95%CI:1.192~1.405, P<0.001)and educational background (without receiving formal education as the reference: primary school OR=0.825,95%CI:0.741~0.920, P<0.001; junior middle school and above OR=0.895,95%CI:0.808~0.991, P<0.001)were the independent influencing factors of glycemic control. Conclusions The glycemic control of the patients with T2DM in Changshu City is not optimistic. It is influenced by residence, smoking, dyslipidemia, central obesity and educational background. It is necessary to actively carry out comprehensive measures to control blood glucose and the occurrence of diabetes complications.