2型糖尿病患者依从性现状及其与社区管理年限的关系研究

背景　社区管理可促进糖尿病患者的依从性行为，有利于维持更好的健康状态。已有研究大多集中于社区管理对糖尿病患者依从性的影响，国内外尚缺乏不同社区管理年限对糖尿病患者依从性影响的研究。目的　了解2型糖尿病患者的依从性情况，探究社区管理年限对2型糖尿病患者依从性行为的影响。方法　于2017年7-9月，选取2017-09-29前在上海市普陀区社区卫生服务中心建卡，并纳入社区管理的2型糖尿病患者15 088例为研究对象，通过社区糖尿病患者管理系统获取患者的人口学资料、疾病相关信息、治疗情况和依从性情况。采用Logistic回归分析社区管理年限对糖尿病患者依从性行为的影响。结果　2型糖尿病患者的平均社区管理年限为（4.05±2.46）年，主要治疗方式是口服降糖药物（10 462例，69.34%），其中，12 156例（80.57%）患者糖化血红蛋白（HbA1c）控制达标，7 621例（50.51%）患者体质指数（BMI）控制良好，5 855例（38.81%）患者腰围控制差（中心性肥胖），9 589例（63.55%）患者血压控制良好。2型糖尿病患者的服药依从率为95.55%（13 107/13 717），不同年龄、病程、治疗方式、BMI控制情况、社区管理年限的2型糖尿病患者服药依从率比较，差异有统计学意义（P<0.05）；饮食控制率为87.19%（13 155/15 088），不同性别、年龄、病程、治疗方式、BMI控制情况、社区管理年限的2型糖尿病患者饮食控制率比较，差异有统计学意义（P<0.05）；规律运动率为47.45%（7 159/15 088），不同年龄、病程、社区管理年限的2型糖尿病患者规律运动率比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，调整性别、年龄、病程、BMI和治疗方式后，中长期管理（1~4年）是规律运动行为〔OR=1.415，95%CI（1.225，1.637），P<0.05〕的促进因素；长期管理（>4年）是服药依从行为〔OR=2.925，95%CI（2.109，4.022），P<0.05〕、饮食控制行为〔OR=2.051，95%CI（1.689，2.481），P<0.05〕、规律运动行为〔OR=2.596，95%CI（2.239，3.016），P<0.05〕的促进因素。结论　2型糖尿病患者的总体依从性情况良好，但规律运动情况欠佳，建议社区管理加强对患者规律运动的指导；长期管理比短期管理更有助于培养糖尿病患者良好的依从性行为，建议社区卫生服务中心及早将确诊患者纳入社区管理，并进行长期管理干预。

Treatment Compliance and Years of Community-based Management in Type 2 Diabetes

Background　Community-based management can improve the treatment compliance to obtain a better outcome in diabete patients. Available related studies mostly focus on the impact of community-based management on the treatment compliance of diabete patients. But the association of treatment compliance and years of community-based management has rarely been studied. Objective　To explore the treatment compliance and its association with years of community-based management in type 2 diabetes. Methods　From July to September 2017，15 088 type 2 diabetes who had applied for a health card and received community-based management as of September 29，2017 were recruited from Shanghai Putuo Community Health Service Center. Data regarding demographics and disease-related information，treatment and treatment compliance were obtained through the community-based diabetes management system. Logistic regression was used to examine the association between years of community-based management and treatment compliance. Results　The average duration of community-based management was （4.05±2.46） years，with oral hypoglycemic drugs as the major intervention（10 462 patients，69.34%）. Among them，12 156（80.57%） met the target HbA1c level，7 621（50.51%） had satisfied BMI control，9 589（63.55%） had good blood pressure control，but 5 855（38.81%） with central obesity did not meet the target waist circumference. The medication compliance was 95.55%（13 107/13 717）. The medication compliance varied significantly by age，course of type 2 diabetes，treatment，BMI control status and years of community-based management（P<0.05）. The diet control rate was 87.19%（13 155/15 088），which varied significantly according to sex，age，course of type 2 diabetes，treatment，BMI control status and years of community-based management（P<0.05）. The regular exercise rate was 47.45%（7 159/15 088）. The regular exercise rate differed significantly by age，course of type 2 diabetes，and years of community-based management（P<0.05）. After adjusting for sex，age，course of type 2 diabetes，BMI and treatment，Logistic regression analysis found that medium- and long-term（1-4 years） community-based management was a facilitator for regular exercise behavior〔OR=1.415，95%CI（1.225，1.637），P<0.05〕. Long-term（>4 years） community-based management was a facilitator for medication compliance〔OR=2.925，95%CI（2.109，4.022），P<0.05〕，good diet control〔OR=2.051，95%CI（1.689，2.481），P<0.05〕，and regular exercises〔OR=2.596，95%CI（2.239，3.016），P<0.05〕. Conclusion　On the whole，the treatment compliance was good in this group of diabetes，but the prevalence of regular exercises was poor. To further improve their treatment compliance，community-based exercise guidance for these patients should be strengthened. Moreover，it is suggested to give community-based management to diagnosed diabetes as early as possible，and long-term management is a better choice since it is more helpful to cultivate good treatment compliance.