2型糖尿病214例相关因素社区控制现状

[目的] 描述和分析社区糖尿病患者的相关因素控制水平。[方法] 随机抽取社区规范管理的214例糖尿病患者,并检测血糖、血压、体质指数、尿微量白蛋白、血脂和糖化血红蛋白水平,并与其他研究结果进行比较分析。[结果] 214例患者控制较好的有血糖、糖化血红蛋白、高密度脂蛋白胆固醇、尿微量白蛋白和主动有氧活动,达标率分别为64.0%、73.8%、63.6%、85.0%和72.4%。控制较差的有血压、低密度脂蛋白胆固醇和体质指数,达标率分别为22.9%、12.6%和41.6%。[结论] 社区糖尿病管理中相关因素的控制情况不理想,要加强医患教育、组建团队、早期检测危险因素并控制达标。     

北京市居民2型糖尿病现况调查和危险因素研究

目的 揭示北京市居民2型糖尿病的流行趋势及探索相关危险因素.方法 采用多因素logistic回归模型分析北京市居民2型糖尿病的相关危险因素.结果 共调查22301人,其中男性9836人,女性12465人,60岁以上2658人,占11.92%.男性(OR=1.453)、有糖尿病遗传史(OR=2.751)、中老年人(OR=1.584)、高血压(OR=1.338)、腹型肥胖(OR=1.741)、超重或肥胖(OR=1.098)、水果摄入量少(OR=1.430)、血清高甘油三酯(OR=1.767)和高胆固醇水平(OR=1.315)是影响2型糖尿病发生的危险因素.结论 控制血压在正常范围、控制体重、增加水果摄入量和降低血清甘油三酯及胆固醇水平,对于北京市居民预防和控制2型糖尿病发生具有重要意义.

Abstract：

Objective To disclose the epidemiological status of type 2 diabetes mellitus and its related risk factors in adults in Beijing.Methods Logistic model was applied to analyze the relationship between the risk factors and type 2 diabetes mellitus.Results A total of 22301 people were studied,of whom 9836 were males,12465 females,and 2658 of them aged over 60(accounting for 11.92%).The risk factors,which might cause diabetes,would include being male(OR=1.453),with genetic history(OR=2.751),people older than 40(OR=1.584),with hypertension(OR=1.338),with larger waist circumference(OR=1.741),overweight or obesity(OR=1.098),low consumption of fruits(OR=1.430),hypertriglyceridemia(OR=1.767)and hypercholesterolemia (OR=1.315).Conclusion It is of great importance to carry out prevention and controI of type 2 diabetes mellitus programs to eliminate the risk factors among adults in Beijing,with contents as:keeping the blood pressure and weight within the normal range,increasing fruit intake,decreasing the triglyceride and cholesterol levels.     

社区居民2型糖尿病与桡动脉反射波增强指数的关系研究

目的探讨2型糖尿病与桡动脉反射波增强指数的关系,为预防动脉粥样硬化性心脑血管疾病(ASCVD)的发生提供依据。方法于2012年采用横断面研究设计,对北京市首钢社区居民进行问卷调查、体格检查、血糖及血脂等生化指标检测,并进行桡动脉反射波增强指数(rAI)检查,通过数学转换获得心率为75次/min时的桡动脉反射波增强指数标准校正值(rAI_(P75))。分析在无ASCVD证据的调查对象中2型糖尿病与rAI_(P75)之间的关系。结果共纳入6 946例研究对象,平均年龄为(55.90±8.63)岁,其中2 475例(35.63%)为男性,2型糖尿病患者1 550例(22.32%)。rAI_(P75)的±s为(80.29±11.90)%。相对于非糖尿病人群[(80.25±11.92)%],2型糖尿病人群具有高的rAI_(P75)水平[(80.46±11.84)%],但差异不具有统计学意义(β=0.214 0,P=0.532 7)。在对年龄、性别、体质指数(BMI)、教育程度、吸烟、饮酒、体育锻炼情况、高血压、高脂血症因素进行控制后,2型糖尿病患者rAI_(P75)升高显著(2型糖尿病患者与非糖尿病患者比较:β=0.757 6,P=0.018 7)。在亚组分析中,在男性、年轻组、无高血压组和现在不吸烟组中得到类似的结果。结论本次调查的无ASCVD证据的社区居民中2型糖尿病与rAI存在相关关系,2型糖尿病组的rAI水平显著升高,且主要体现在男性及低危(年龄小于55岁、无高血压、不吸烟)人群中。这提示在男性及低危的2型糖尿病患者中更应定期监测rAI,关注ASCVD的进展。     

Development of a preliminary diabetes dietary satisfaction and outcomes measure for patients with type 2 diabetes

Adopting dietary lifestyle changes for diabetes management is often difficult for patients; yet the health-related quality of life (HRQOL) outcomes of dietary management for the patient are not extensively developed in the HRQOL assessments now widely used in diabetes research. This study developed a preliminary instrument, the diabetes dietary satisfaction and outcomes measure, to assess outcomes of individuals' experiences in following a meal plan for the treatment of type 2 diabetes. A theoretical framework and preliminary focus group data guided the design of a 47-item questionnaire, administered to 239 patients with type 2 diabetes. Medical file data was obtained on 180 of these patients. Fifty-four percent of respondents were women, with mean age of 64 +/- 12 years and diabetes duration of 10 +/- 8 years. Scores for the satisfaction and other outcome measures discriminated between patient groups by age, gender, medication use, depression diagnosis, meal plan status, and employment status. Significant correlations also occurred with diet adherence, number of co-morbidities, and glycemic control as measured by glycolated hemoglobin (HbA1c). Future research with additional patient samples is needed to refine the measure for use in diabetes education programs.     

2型糖尿病患者膳食质量与血糖控制的相关性研究

目的 评估2型糖尿病患者膳食质量与血糖控制的关系。方法 2019年采取整群抽样法,对蚌埠市某社区332名2型糖尿病患者进行问卷调查,获得人口社会学、膳食摄入、生化指标等信息。使用中国膳食平衡指数-16评价整体膳食质量,检测糖化血红蛋白评价血糖控制状况。构建受试者工作特征曲线以找到中国膳食平衡指数-16分值截断值,将患者分为膳食质量相对较低和较高组,对两个组别进行统计分析。建立logistic回归模型评价患者膳食质量与血糖控制的关系,以糖化血红蛋白含量≥7％作为因变量,调整月收入、生命质量、并发症、总胆固醇和低密度脂蛋白水平。结果 共有290例2型糖尿病患者被最终纳入分析。中国膳食平衡指数-16膳食质量距得分<26％为分组最佳截断值（受试者工作特征曲线下面积0.58,敏感性为74.0%,特异性为45.0%,P=0.020）。饮食质量较高组患者生命质量自我评分、血浆低密度脂蛋白水平较饮食质量较低组高(Z=-3.821、-2.317,P<0.05),差异有统计学意义。调整混杂因素后,低饮食质量组患者血糖控制不良（OR=1.84,95%CI为1.06~3.20;P=0.03）的概率是高饮食质量组的2倍。结论 社区2型糖尿病患者较低的饮食质量（定义为DBI-16膳食质量距得分>26％）与血糖控制不良有关,通过评价整体饮食质量提供相关饮食建议可能是改善患者血糖控制水平的有效方法。     

Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes

A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p < 0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06–1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80, 95 % CI 0.70‒0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73‒0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44, 95 % CI 1.96–3.03) and at 12 months (OR 2.70, 95 % CI 2.18–3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making.     

昆明市城乡居民劳动强度对2型糖尿病患病率的影响

目的探讨昆明市20岁及以上城乡居民劳动强度与2型糖尿病(T2DM)的关系。方法采用多阶段抽样方法,随机抽取昆明市20岁及以上城乡居民5 191人,进行问卷调查、人体测量及生化指标检测。统计学处理采用SPSS统计软件,率的比较用χ2检验,P0.05为差异有统计学意义。结果调查对象的血压、体质指数(BMI)、腹围、空腹血糖(FPG)、2 h葡萄糖耐量实验(2h-OGTT)、糖尿病患病率均随劳动强度的增加而下降(P均0.001)。轻体力劳动(43.9%)、中等体力劳动(42.9%)和重体力劳动(13.2%)的糖尿病患病率分别为8.1%、4.5%和1.9%。多因素logistic回归分析,在调整了年龄、性别、肥胖等多种潜在混杂因素之后,轻体力劳动组、中等体力劳动组和重体力劳动组糖尿病的OR值分别为0.73(95%CI:0.44~1.31),0.58(95%CI:0.35~0.94),趋势分析P=0.02。结论体力劳动强度对糖尿病的患病率有明显的保护作用,经常性的适度体力劳动有助于降低居民糖尿病患病风险。     

阿托法他汀治疗2型糖尿病效果的Meta分析

目的 综合评价阿托伐他汀(10mg/d)治疗2型糖尿病的效果与常规疗法治疗的差别.方法 在万方、CNKI、维普数据库中检索2000-2010年发表的中文相关文献,主要入选标准包括:①随机对照试验(RCT);②试验组阿托伐他汀(10mg/d),对照组采用常规疗法治疗;③疗程为3~12周;④评价指标包括LDL-C、HDL....     

那格列奈治疗2型糖尿病的疗效及安全性

目的　观察那格列奈治疗 2型糖尿病的疗效及安全性。方法　经 4周清洗期后符合标准的 5 8例患者随机分为那格列奈组 (2 8例 )和瑞格列奈组 (30例 ) ,治疗前后测定空腹血糖(FBS)、餐后 2h血糖 (PBS)、糖化血红蛋白 (HbA1 c)及肝、肾功能等。结果　那格列奈组治疗后FBS、PBS和HbA1 c均显著下降 (P <0 .0 1 ) ,与瑞格列奈组比较无显著性差异。两组均无肝肾功能损害。结论　那格列奈有明确的降低空腹、餐后血糖及糖化血红蛋白的作用 ,不良反应少 ,是一种安全、有效的降糖药物。     

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA1c > or = 7%). Data were collected from the medical records. 1641 patients were included who had mean HbA1c 7.1(SD 1.7)% , and 42% had HbA1c > or = 7%. On univariate analysis younger age; longer duration of diabetes; higher levels of blood glucose at diagnosis; most recent fasting blood glucose (FBG), total cholesterol, and triglyceride; higher body mass index (BMI); treatment with oral hypoglycaemic agents (OHA); treatment with insulin; more GP-visits for diabetes in the last year; and lower educational level were associated with poor control. Both in multiple linear regression and in multiple logistic regression higher levels of FBG (odds ratio (OR): = 1.6, 95% confidence interval (CI): 1.49, 1.70), treatment with OHA (OR: 2.1, 95% CI: 1.41, 3.04), treatment with insulin (OR: 7.2, 95% CI: 4.18, 12.52), lower educational level (OR: 1.26, 95% CI: 1.01, 1.56) were independently associated with poor levels of HbA1c. When FBG levels were excluded from the model, higher blood glucose at diagnosis, higher values for triglyceride and total cholesterol, and younger age predicted poor glycaemic control, but these variables explained only 15% of the variation in HbA1c. In conclusion prediction of poor glycaemic control from patient characteristics in diabetic patients in general practice is hardly possible. FBG appeared to be a strong predictor of HbA1c, which underlines the usefulness of this simple test in daily diabetes care. The worse metabolic control in those treated with either OHA or insulin suggests that current treatment regimes might be not sufficiently applied to reach the targets of care. Providers of diabetes care should be attentive to patients with lower educational level.     

上海市闵行区糖尿病患者膳食与营养状况调查

[目的]通过对上海市闵行区糖尿病患者的膳食与营养状况调查,找出糖尿病患者营养状况存在问题,探讨解决措施。[方法]从本区糖尿病管理数据库中,按1%比例抽样,对373例样本采用72 h膳食回顾法调查3 d的膳食情况,并进行血糖、糖化血红蛋白、血脂等检测。数据录入\     

硒与2型糖尿病关系的流行病学证据

2型糖尿病(T2DM)是全球最常见的代谢性疾病.国际糖尿病联合会预测糖尿病患者将从2011年的3.66亿上升到2030年的5.52亿^[1];我国的T2DM患病率高达9.7%,估计有9240万患者,并有逐年上升趋势^[2].而饮食在糖尿病的形成过程中起着关键作用,因此一级预防显得尤为重要.硒是人体必需微量元素,以往就认识到一些硒蛋白(如谷胱甘肽过氧化物酶GPX1)的抗氧化作用和硒的类胰岛素作用,据此推测补硒可能预防T2DM.然而,硒和T2DM的关系并非如此简单,涉及到的主要机制是胰岛素信号传导的氧化还原矛盾(redox paradox),H2O2等活性氧(ROS)除了具有自由基的攻击性,也是胰岛素信号传导的第二信使,GPX1等硒蛋白能够清除多余的自由基,保护胰岛的正常功能,但其过量表达则可清除第二信使H2O2,导致胰岛素信号传导过程的磷酸化异常,最终血糖调节失控,长期以往可能发生T2DM^[3].笔者总结已往发表的流行病学资料,就血硒水平/补硒与T2DM患病/发病的关系进行复习,以探讨其中的流行病学证据.     

72例老年2型糖尿病合并高血压的分析

目的 探讨高血压对老年2型糖尿病的影响及各靶器官的损害.方法 72例2型糖尿病合并高血压病人按血压轻、中、重度分为A、B、C3组,对照组D组为45例血压正常的2型糖尿病患者,对比分析两组的脑梗死、冠心病、糖尿病肾病及眼底病交的发生率.结果 4组患者脑梗死(P=0.03)、冠心病(P=0.02)、糖尿病肾病(P=0.003)及眼底病变(P=0.002)的发生率具有极显著的统计学差异.结论 老年2型糖尿病患者合并高血压脑梗死、冠心病、糖尿病肾病及眼底病变风险增高,且其严重程度随血压的增高而加重.     

吡咯列酮治疗2型糖尿病的疗效及安全性分析

目的探讨2型糖尿病患者采用吡咯列酮治疗的疗效与安全性。方法将我院2012年1月—2013年1月接待的88例2型糖尿病患者作为研究对象,随机均分为研究组与对照组,对照组采用格列吡嗪治疗,研究组采用盐酸吡咯列酮片治疗,对两组患者治疗效果进行观察分析。结果两组患者在治疗后,FBG、PBG2h、HbA1c、TG相较于治疗前皆有明显改善,但研究组改善更为明显,差异性显著（P〈0.05）;研究组在治疗效果及不良反应发生率皆明显优于对照组,差异性显著（P〈0.05）。结论采用盐酸吡咯列酮片治疗2型糖尿病患者可以取得比较明显的效果,而且治疗过程中不良反应较少,值得临床推广及应用。     

上海市2012年社区在册糖尿病和高血压患者抑郁、焦虑阳性率及其影响因素

目的探讨团体认知行为治疗对伴发焦虑抑郁的糖尿病患者的疗效。方法采用随机双盲对照试验,选取上海市奉贤区内伴有焦虑抑郁情绪的糖尿病患者42例,分别接受10周的团体认知行为治疗(GCBT)或仅糖尿病健康教育。治疗前后分别采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、席汉残疾量表(SDS)对两组患者进行评估并检测空腹血糖等疗效指标。结果10周干预结束后,两组被试间空腹血糖值的差异无统计学意义,治疗后两组HAMD、HAMA、SDS评分明显下降,治疗前后两组评分的差异具有统计学意义(F分别为6.801、10.30、5.02,P分别为0.013、0.003、0.031),实验组治疗前后HAMD差值与病程、学历负相关(r分别为-0.486、-0.541,P分别为0.030、0.014),而SDS差值与性别差异显著相关,女性SDS评分下降更显著(r=0.582,P=0.007)。结论团体认知行为治疗有助于改善伴发焦虑抑郁的糖尿病患者的情绪,有利于恢复社会功能和提高生活质量。