江苏省2型糖尿病患者血糖控制及治疗用药情况调查

目的了解江苏省2型糖尿病（T2DM）患者的血糖控制情况，分析治疗方法与血糖控制的关系。方法采用横断面研究方法，以调查问卷形式收集患者年龄、病程、降糖药物的使用情况等，留取血标本检测HbA1c。根据HbA1c水平将患者分为达标组（HbA1c〈6．5％）和未达标组（HbA1c≥6．5％）；根据降糖治疗情况分为胰岛素（Ins）组、胰岛素联用口服降糖药（Ins＋OA）组、口服降糖药（OA）组、生活方式干预（LS）组。结果入选T2DM患者2966例，年龄（56．4±11．2）岁，糖尿病平均病程（6．3±5．7）年，HbA1c值（7．2±1．6）％，HbA1c≥6．5％的患者占59．8％。（1）平均病程Ins组[（7．6±6．5）年]与Ins＋OA组[（8．2±6．2）年]均高于OA组C（5．3±5．0）年]（P〈0．01）。HbA1c均值及未达标比例Ins组[（7．4±1．6）％，未达标比例65．9％]与Ins＋OA组[（7．5±1．5）％，未达标比例77．9％]均高于OA组[（7．0±1．6）％，未达标比例52．4％]（P〈0．01）。（2）HbA1c达标组与未达标组病程分别为（4．8±4．9）年和（7．3±6．1）年（P〈0．01），两组中胰岛素联合口服降糖药治疗者分别占11．5％和27．2％（P〈0．01），单用胰岛素治疗者分别占17．0％和22．1％（P〈0．01）。结论江苏省T2DM患者血糖控制现状比3年前全国调查情况有所改善，但仍有相当比例的患者HbA1c水平没有达到IDF及《中国2型糖尿病防治指南》推荐标准。接受胰岛素治疗的患者HbA1c均值及不达标比例明显高于其他治疗组，表明由于病程延长及口服降糖药用药失效导致病情恶化后，再选择胰岛素治疗，血糖控制情况并不理想。

Investigation of glycemic control and antidiabetic therapy in type 2 diabetic patients in Jiangsu province

Objective To evaluate glycemic control and its correlation with therapeutic strategies among type 2 diabetic patients of Jiangsu province. Methods In 2966 type 2 diabetic outpatients, a questionnaire interview was performed to collect the data of age, weight, height, diabetes duration and therapeutic management. Inadequate glycemic control was defined as HbA1c 〉/6.5%. Therapeutic managements were divided into oral antiglycemic agents（OA）,OA plus insulin, insulin only, and lifestyle improvement only. Results The enrolled patients had the mean age of 56. 4±11.2 years, mean diabetes duration of 6.3±5.7years, mean HbA1c of 7.2%±1.6%, and 59. 8% patients had HbA1c≥6.5%. The mean diabetes duration was 7.6±6.5 years in insulin only group and 8. 2±6.2 years in insulin plus OHA. The mean HbA1c of the two groups were 7. 4%±1.6% and 7. 5%±1.5%. Inadequate glycemic control in insulin only group （65.9%） and insulin plus OHA （77.9%） were more frequent than in the OHA group （52.4%） （P〈0.01）. The mean duration of patients with HbA1c〈6.5% and HbA1 c≥6.5% was 4. 8±4. 9 years and 7. 3±6.1 years, respectively（P〈0. 01）. More patients in the HbA1c≥6.5% groupwere prescribed insulin therapy than those in HbA1c≥6.5% group （insulin only： 22. 1% vs 17. 0%, P〈 0.01）. insulin plus OHA.. 27.2% vs 11.5%）（P〈0.01）. Conclusions 1. Although the state of diabetes control is improved in type 2 diabetes in Jiangsu province, many patients do not achieve the optimal control target. 2. Patients with poor glycemic control are more likely prescribed insulin or combination of insulin with OHA, suggesting that insulin is selected too late to protect β-cell function after OHA failure. However, the results show that glycemic control is still not optimal after insulin therapy.