2013年常熟市2型糖尿病患者的血糖、血脂及血压控制情况及影响因素分析

目的 评估常熟市2型糖尿病患者血糖、血压及血脂控制情况,探讨其影响因素,为优化社区糖尿病管理提供依据。方法 对2013年常熟市社区管理的10 238例2型糖尿病患者进行调查,根据中华医学会糖尿病学分会(Chinese Diabetes Society, CDS)的综合控制目标,评估血糖、血压及血脂的达标情况。结果 10 238例被调查者的糖化血红蛋白(Hemoglobin A1c,HbAlc)平均值为(7.60±1.58)%,达到控制目标(HbA1c<7.0%)的比例为40.84%。SBP平均值为(150.06±20.05)mmHg,达标率为32.01%,DBP平均值为(80.76±10.33)mmHg,达标率为46.70%,两者同时达到控制目标(<140/80 mmHg)的比例为22.33%。TG平均值为(1.96±1.60)mmol/L,达标率为56.80%, TC平均值为(5.24±1.11)mmol/L,达标率为23.82%,HDL-C平均值为(1.50±0.41)mmol/L,达标率为78.43%,LDL-C平均值为(3.13±0.90)mmol/L,达标率为25.22%。除HDL-C外,血脂其余三项指标检测平均值均超过糖尿病综合控制目标值,差异有统计学意义(均P<0.05)。多因素非条件logistic回归分析显示,地区(OR=1.351,OR95%CI:1.242~1.470 )、血脂(OR=1.257,OR95%CI:1.156~1.367)、吸烟(OR=1.297,OR95%CI:1.082~1.554)、腰围(OR=1.290,OR95%CI:1.184~1.404)、性别(OR=0.698,OR95%CI:0.638~0.763)、年龄:(OR=0.897,OR95%CI:0.854~0.941)、用药情况(OR=1.244,OR95%CI:1.208~1.282)、收缩压(OR=1.208,OR95%CI:1.104~1.322)、糖尿病病程(OR=1.517,OR95%CI:1.450~1.588)是血糖控制的独立影响因素。生活在农村、吸烟、男性、年龄50岁以下、用药不佳、糖尿病病程长,血脂、腰围、收缩压控制不良均不利于血糖的控制。结论 2013年常熟市2型糖尿病患者血糖、血压和血脂控制达标率不够理想,影响因素有地区、吸烟、性别、年龄、用药情况、糖尿病病程、血脂、腰围、收缩压等,应积极开展综合措施控制血糖和糖尿病并发症的发生。

Status and influencing factors of glucose,blood lipid and blood pressurecontrol among patients with type 2 diabetes mellitus in Changshu City, 2013

Objective To evaluate the status of glucose, blood pressure and lipid control among patients with type 2 diabetes mellitus in Changshu City, and to explore their influencing factors so as to provide a basis for optimizing the management of diabetes mellitus in communities.Methods We investigated 10,238 type 2 diabetes mellitus patients managed by communities in Changshu City in 2013, and then evaluated the standard-reaching situation of glucose, blood pressure and lipid according to the comprehensive control goal of Chinese Diabetes Society.Results The average levels of hemoglobin A1c (HbAlc), systolic blood pressure (SPB) and diastolic blood pressure (DPB) in the 10,238 surveyed subjects were (7.60 ±1.58)%, (150.06 ±20.05) mmHg and (80.76±10.33) mmHg respectively, with the compliance ratios being 40.84% (HbAlc<7.0%), 32.01% and 46.07% respectively. The proportion of both SPB and DPB simultaneously reaching the control target (<140/80 mmHg) was 22.33%. The mean values of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were (1.96±1.60) mmol/L,(5.24 ±1.11)mmol/L, (1.50±0.41) mmol/L and (3.13±0.90) mmol/L, with the compliance ratios being 56.80%, 23.82%, 78.43% and 25.22% respectively. The mean values of the above-mentioned blood lipid indexes except HDL-C were higher than the target values of diabetes comprehensive control, and the differences were statistically significant (all P<0.05). Multi-factor unconditional logistic regression analysis showed that residence (OR=1.310,95%CI:1.242-1.470), blood lipid(OR=1.257, 95%CI:1.156-1.367), smoking(OR=1.297, 95%CI:1.082-1.554), waist circumference(OR=1.290, 95%CI:1.184-1.404), sex (OR=0.698, 95%CI:0.638-0.763), age(OR=0.897,95%CI:0.854-0.941), pharmacotherapy(OR=1.244, 95%CI:1.208-1.282), SPB(OR=1.208, 95%CI:1.104-1.322)and diabetes course(OR=1.517, 95%CI:1.450-1.588) were the independent factors influencing glucose control.Conclusions The control rates of glucose, blood pressure and lipid of type 2 diabetic patients in Changshu City in 2013 was not satisfactory, and the influencing factors were residence, smoking, sex, age, pharmacotherapy, course of diabetes, blood lipid, waist circumference, SBP and so on. Comprehensive measures should be carried out to control glucose and occurrence of complications of diabetes.