门诊2型糖尿病患者控制及降糖药物治疗现状调查分析

目的评估门诊2型糖尿病患者代谢控制达标情况及降糖药物治疗的现状。方法随机选取343例门诊2型糖尿病患者,根据《2007年中国2型糖尿病防治指南》,横断面评估其HbA1c及血脂谱、血压达标情况;分析患者降糖药物使用及大血管并发症出现的概况。结果 343例患者中HbA1c≤6.5%达标比例为21.9%;空腹及餐后血糖达到良好控制比例分别为24.5%和30.3%。33.2%患者血压得到较好的控制,各血脂指标仅有1/3患者达标。口服降糖药物使用比例依次为二甲双胍（48.4%）、磺脲类（36.4%）、糖苷酶抑制剂（33.5%）、胰岛素增敏剂（26.5%）、格列奈类（16.3%）。治疗方案中单药治疗占25.4%、两种及三种以上药物分别占39.1%及11.0%、口服药联合胰岛素占24.5%;HbA1c达标情况随以上治疗顺序而显著降低,并与各治疗组糖尿病病程相关。大血管并发症中以高血压最明显,占61.2%。结论我院门诊2型糖尿病患者血糖控制达标率稍高于全国调查,但仍有78.1%的患者未达到理想控制。早期采用药物联合及胰岛素治疗可能改善门诊糖尿病患者的治疗状况。

A Survey on Status of Blood Glucose Control and Hypoglycemic Agents Treatment in Outpatient Patients with Type 2 Diabetes

Objective To assess the status of metabolic control and hypoglycemic agents treatment in outpatient type 2 diabetic patients.Methods This survey recruited 343 type 2 diabetic patients randomly.According to the Chinese Guideline on Prevention and Treatment of Type 2 Diabetes,a cross-sectional investigation was performed to evaluate targeted status of HbA1c,lipid profile and blood pressure.Hypoglycemic agent protocols and occurrence of macrovascular complications were analyzed simultaneously.Results There were 21.9% of informants targeted HbA1c ≤ 6.5%,while 24.5% and 30.3% of informants got well control in fasting and postprandial plasma glucose respectively.33.2% of patients targeted well blood pressure control,and only 1/3 of them were up to the targeted standard of lipid profile.The ordinal ratio of oral antidiabetic drugs（OAD） consumption was metformin（48.4%）,sulfonylureas（36.4%）,α-glucosidase inhibitors（33.5%）,TZDs（26.5%）,and glinides（16.3%）.For therapeutic protocols,25.4% of patients were undertaking the single OAD treatment,while 39.1% of patients with two kinds of OAD and 11.0% with three kinds or more,24.5% of patients were treated with OADs combined with insulin.Consequently,the targeted ratio of HbA1c significantly decreased in accordance with the above protocol sequence,and correlated to the diabetic duration of each protocol group.The most common marcovascular complication was hypertension（61.2%）.Conclusion The targeted rate of blood glucose control in our survey is a little higher than results from national survey,but there have been still 78.1% of patients far from the guiding standard.Early initialization of OADs combined with insulin may improve the situation of outpatient diabetic treatment.