中国城市地区口服降糖药治疗的2型糖尿病患者血糖控制达标现状

目的了解中国城市地区口服降糖药治疗的2型糖尿病（T2DM）患者的口服药治疗模式、血糖控制达标率及相关因素。方法2010年7月至9月在全国30个省级行政区81个城市的414家医院，入选目前接受单纯口服降糖药治疗的门诊T2DM患者，收集患者的一般资料、糖尿病病史、实验室检查结果及治疗方案，以了解中国城市地区口服降糖药治疗的T2DM患者的口服药治疗模式、血糖控制达标率及相关因素。血糖达标的相关性分析采用逻辑回归模型分析。结果共纳入97315例T2DM患者，平均年龄（59±11）岁，病程（5±4）年，糖化血红蛋白（HbAlc）为7．7％±1．6％，HbAlc〈7．0％者34154例（35．1％），HbAlc〈6．5％者17380例（17．9％）。调查患者中12748例（13．1％）合并有至少1种大血管病变，14694例（15．1％）合并有至少1种微血管病变，合并有大或微血管并发症的患者血糖达标率分别为27．3％和25．2％，均低于未合并血管并发症组的36．3％和36．9％。口服药治疗方案中，双药（51．3％）、单药（34．5％）治疗较为常见，在单药、双药、3种药物和4种及以上药物联合治疗患者中，血糖达标率分别为40．6％、33．7％、27．0％和24．5％；单药治疗中，应用较多的为双胍类（30．8％）、磺脲类（24．6％）和格列奈类（21．1％）；联合治疗中双胍类联合磺脲类者为23．7％，双胍类联合格列奈类者为13．6％。回归分析显示男性、糖尿病病程、口服药物种类数、体质指数、大血管病变、微血管病变与HbAlc达标率均呈显著负相关（OR=1．025、0．855、0．868、0．852、0．789、0．698，均P〈0．01）。结论在中国应用口服药的T2DM患者中血糖控制达标率低，应进一步加强糖尿病管理，及时改变治疗方案，有效改善患者血糖控制状况。

Glycaemic control in patients with type 2 diabetes treated with oral antidiabetic drugs in urban areas of China

Objective To investigate glycemic control, treatment regimen and other relevant characteristics in patients with type 2 diabetes mellitus（T2DM） treated with oral antidiabetic drugs （OADs） only in urban areas of China. Methods A total of 414 hospitals from 81 cities across China participated in the survey. Outpatients with T2DM on OADs treatment only were eligible for this study. General information of patients, medical history for T2DM, laboratory investigations and treatment regimen were collected from July to September in 2010. Logistic regression analysis was applied in the correlation analysis of glycemic control. Results A total of 97 315 eligible patients with T2DM were included in this study, with a mean age of （59 ± 11 ） years and a mean diabetes duration of （5 ± 4） years. The mean glycated hemoglobin Alc （HbAlc） level of all patients was 7.7% ± 1.6%. Total of 35. 1% （34 154 cases） and 17. 9% （ 17 380 cases） of the patients had a HbAlc 〈 7.0% and 〈 6.5% , respectively. Among all the patients, 13.1% （12 748 cases） complicated with at least one macrovascular disease, and 15.1% （14 694 cases） with at least one microvascular disease. Of the patients with macrovascular complication （s） , 27. 3% achieved optimal glycemic target （HbAlc 〈 7.0%）, it was lower than that in patients without macrovascular complication （s） （36. 3 % ）. Similarly, 25.2% of the patients with microvascular complication （s） achieved optimal glycenfic target and it was lower than that in patients without microvascular complication （s） （36. 9% ）. Among all the OAD treatment regimens, two kinds of OADs （51.3%） and one OAD （34. 5% ） were most frequently used. It＇s found that 40. 6% , 33.7% , 27.0% and 24.5% of the patients receiving one OAD, two OADs, three OADs and four or more OADs achieved glycemic control target, respectively. The most frequently used OADs were biguanides （ 30. 8% ） , sulphonylureas （ 24.6% ） and glinides （21.1% ）. Among the combined treatment regimens, 23.7% were biguanides plus sulphonylureas, 13.6% were biguanides plus glinides. Regression analysis showed that male, duration of diabetes, kinds of OADs, body mass index, combined with macro or micro vascular diseases were inversely associated with rate of achieving HbAlc target （ OR = 1. 025,0. 855,0. 868,0. 852,0. 789,0. 698, all P 〈 0. 01 ）. Conclusions The status of glycemic control of patients with T2DM treated with OADs only is undesirable in China. Efforts in providing professional education on management of T2DM and adjusting treatment regimen in time are needed to improve glycemic control.