新疆10个糖尿病治疗中心不同病程2型糖尿病患者疾病控制现状分析

背景:目前,国内糖尿病患者中各种慢性并发症发生率较高,已接近发达国家水平,新疆糖尿病患病率又远高于全国水平,整体疾病控制水平较低。目的:了解新疆地区2型糖尿病患者疾病控制现状,分析其与病程的关系。设计:整群抽样,分层分析。单位:武装警察部队新疆总队医院内分泌科。对象:调查于2001-01/09由新疆10个中心(新疆医科大学第一附属医院、新疆维吾尔自治区人民医院、空军乌鲁木齐医院、新疆维吾尔自治区铁路局医院、新疆生产建设兵团医院、新疆伊犁州奎屯中心医院、新疆克拉玛依市人民医院、新疆库尔勒市人民医院、新疆生产建设兵团农一师医院及新疆维吾尔自治区中医医院)共同完成,每个中心按整群抽样方法随机抽取在该中心进行糖尿病治疗超过12个月的2型糖尿病患者646例,男337例,女309例,按病程分为6组:<3年202例,3～4年89例,5～6年89例,7～9年77例,10～14年108例,≥15年81例。均对调查项目知情同意。方法:①患者自我检测血糖及尿糖分别采用便携式血糖仪及尿糖试纸。经常控制饮食定义为1周至少4d能按照糖尿病饮食原则进食。经常运动定义为1周至少3d,每天至少30min强度适度运动。糖尿病并发症结合临床表现、病史及客观检查结果诊断。调查采取结合患者来院检诊及写信、电话询问进行。②计数资料差异比较采用χ2检验。主要观察指标:不同病程糖尿病患者血糖、尿糖自我检测情况、生活方式管理情况、并发症发生情况、糖尿病治疗情况比较。结果:在家中定期检测血糖和尿糖,参与生活方式管理情况观察,糖尿病并发症发生现状观察,糖尿病治疗情况观察的资料完整的患者数分别为645,645,643,646例。①不同病程患者每个月在家中自我检测尿糖、血糖的比例差异不明显(P>0.05)。②不同病程糖尿病患者控制饮食、运动情况差异不明显(P>0.05)。③病程<15年糖尿病患者大血管及手足并发症、视网膜病变、蛋白尿阳性比例呈逐渐增高,病程≥15年糖尿病患者该比例则降低(χ2=34.16,60.64,49.18,P=0.00)。④不同病程患者糖尿病治疗采用单纯饮食控制及运动、单纯口服降糖药、单纯胰岛素、胰岛素加口服降糖药几种方案的比例不同(χ2=97.88,P=0.00)。病程早期,采用单纯饮食控制或单纯口服降糖药治疗患者比例较高,随病程延长,采用胰岛素,或胰岛素加口服降糖药治疗的患者比例逐渐增大。结论:①患者自我检测血糖及尿糖比例与病程无关。②控制饮食程度及运动程度与病程无关。③病程<15年的糖尿病患者各种并发症发生比例随病程而增加,但>15年的病程组中此比例则显著降低。④病程早期,采用单纯饮食控制或单纯口服降糖药治疗的患者较多,随着病程延长,采用胰岛素,或胰岛素加口服降糖药治疗的患者较多。

Analysis of the actuality of controlling type 2 diabetes mellitus in patients with different disease courses at 10 treatment centers for diabetes mellitus in Xinjiang Uigur Autonomous Region

BACKGROUND: In China, diabetic patients suffer from various chronic complications with a higher prevalence, which is nearly close to that in developed countries. Especially in Xinjiang, the prevalence is much higher than the average level, and the level of disease control is very poor as a whole.OBJECTIVE: To study the actuality of controlling type 2 diabetes mellitus in Xinjiang so as to analyze its relationship with disease courses.DESIGN: Cluster sampling and stratified analysis.SETTING: Department of Endocrinology, Xinjiang General Hospital of Chinese People's Armed Police Forces.PARTICIPANTS: The survey was conducted at ten treatment centers of Xinjiang(the First Affiliated Hospital of Xinjiang MedicalUniversity, People's Hospital of Xinjiang Uigur Autonomous Region, Urumchi Hospital of Air Force of Chinese PLA, Railway Hospital of Xinjing Uigur Autonomous Region, Military Unit Hospital of Xinjiang, Kuitun Central Hospital of Yili Region of Xinjiang, Kelamay People's Hospital of Xinjiang, Kuler People's Hospital of Xinjiang, the First Division Hospital of Xinjiang Military Unit for Produce and Building, Xinjiang Hospital of Traditional Chinese Medicine). Totally 646 type 2 diabetic patients who had received treatment for diabetes mellitus for 12 months, at any of the centers were randomly recruited with cluster sampling method including 337 males and 309 females. According to different courses of disease, the subjects were divided into 6 groups: 202 cases in group of ＜ 3 years, 89 in group of 3-4 years,89 in group of 5-6 years, 77 in group of 7-9 years, 108 in group of 10-14years, and 81 in group of ≥ 15 years. All the subjects agreed to participate in the survey.METHODS: Patients detected their blood sugar level and urine sugar level themselves with portable diabetograph and test paper. For them, there were at least four days per week to take diabetic diet which was considered as common diet control, and there were at least three days per week to participate in leisure activity and at least half an hour per day to spend in proper exercise which was considered as frequent exercise. Complications of diabetes mellitus were diagnosed with clinical manifestation, disease history and objective examination. The survey was performed through letter,telephone counseling, and patient's reexamination. Enumeration data was analyzed with chi-square test.MAIN OUTCOME MEASURES: Differences in blood sugar, urine sugar, management of living style, prevalence of complications in all the diabetic patients with different courses of disease.RESULTS: There were 645, 645, 643, 646 patients with complete data of blood sugar and urine sugar determined periodically at home, participated in the observation of the management of living style, prevalence of diabetic complications and treatment for diabetes mellitus, respectively. ①There was no significant difference in blood sugar and urine sugar level deter mined at home every month among patients of different courses (P ＞ 0.05). ② There was no difference in diet control and exercise among patients of different courses (P ＞ 0.05). ③In patients with disease course of ＜ 15 years, prevalence of the complication in large vessels and extremity,retinopathy, and positive expression of proteinuria presented an increased tendency; whereas, a decreased tendency was found in patients with the disease course of ≥ 15 years(χ2=34.16,60.64,49.18,P=0.00). ④The proportion of applied therapies, such as diet control and exercise, oral antidiabetic drug, insulin, and insulin plus oral anti-diabetic drug, was different in patients with different disease courses (χ2=97.88 ,P=0.00). In patients with short disease courses, diet control or oral anti-diabetic drug was administrated more usually; in those with long disease courses, insulin treatment or insulin plus oral anti-diabetic drug was applied more frequently.CONCLUSION: ①Whether patients determine their blood sugar and urine sugar levels by themselves is not correlated with patients' disease courses. ②Diet control and exercise are not in correlation with disease courses. ③ For patients with the disease course of less than 15 years, the proportion of prevalence of various diabetic complications is increased with the increase of disease courses; for those with the disease course of more than 15 years, however, it is decreased significantly. ④Simple diet control or oral anti-diabetic drug is often applied in patients with short disease courses while insulin or insulin plus oral anti-diabetic drug are administrated in most patients with long disease courses.