2型糖尿病患者糖化血红蛋白控制与自我管理相关因素的关系研究

目的了解2型糖尿病患者血糖化血红蛋白(HbA1c)控制水平与自我管理相关因素的关系。方法采用横断面调查的方法,从4个城市15家医院内分泌科门诊连续募集现患病例。由经过统一培训的调查员采用问卷调查的方式收集患者的一般人口学信息、自我管理信息,同时采集患者5μl指尖血送各城市指定医院进行HbA1c检测。运用logistic回归模型探讨自我管理相关因素与患者HbA1c控制水平的关系。结果共收集有效问卷1524份。多因素分析结果显示控制饮食(OR=0.49,95%CI:0.34～0.72),遵从医嘱(OR=0.63,95% CI:0.40～0.98),监测血糖(≤4次/月:OR=0.66,95% CI:0.50～0.87;>4次/月:OR=0.51。95% CI:0.36～0.73),知晓糖尿病相关知识(OR=0.60,95% CI:0.46～0.80)和检测HbA1c(≥3次/年:OR=0.33,95% CI:0.23～0.48;0～3次/年:OR=0.57,95% CI:0.43～0.74)是HbA1c控制的促进因素。结论自我管理有助于2型糖尿病患者的HbA1c控制,建议加强患者的自我管理以促进HbA1c控制。

Impacts of self-management on glycaemic control among type 2 diabetic outpatients in urban China

Objective To explore the influences of patients' self-management to glycaemic control among type 2 diabetic mellitus (T2DM) outpatients in urban China. Methods A cross-sectional study was carried out in 1524 T2DM outpatients from 15 hospitals in 4 major cities of China. Questionnaire interview was used by trained surveyors to collect data on general characters and self-management. HbA1c test was applied to measure blood glucose in the centralized hospital in each city. Logistic regression was used to examine the association between self-management components including diet control,knowledge,blood monitoring and regular exercises and level of HbA1c. Results 1524 outpatients were enrolled in the study. Multivariate analysis showed that patients who were under diet control (OR=0.49,95%CI: 0.34-0.72),knowledgeable on DM (OR=0.60,95%CI: 0.46-0.80), compliance behavior(OR=0.63,95%CI:0.40-0.98),having regular monitoring on blood glucose (≤4 times/month:OR=0.66,95%CI: 0.50-0.87; >4times/month: OR=0.51,95%CI: 0.36-0.73) and examining HbA1c(≥3 times per year: OR=0.33,95%CI:0.23-0.48; 0-3 times per year: OR=0.57,95%CI:0.43-0.74)were more likely to have a better glycaemic control measured by HbA1c. Conclusion Diet control,knowing diabetes,compliance behavior and regular monitoring on blood glucose and examining HbA1c can improve the glycaemic control among T2DM outpatients in urban China.