新诊断2型糖尿病患者综合管理6年后的达标情况及影响达标的因素分析

目的 观察新诊断T2DM患者综合管理6年后代谢指标的达标情况并分析其影响因素.方法 157例新诊断T2DM患者专人管理并定期随访,给予综合干预.结果 （1）随访6年后SBP、DBP、FPG、2 hPG、HbA1 c、TG、TC、LDL-C水平较干预前降低,HDL-C升高（P＜0.05）.随访6年后与新诊断时达标率比较,SBP：75.2％vs52.9％,DBP：66.9％vs40.8％,BP：61.8％ vs 33.1％,FPG：59.2％vs19.7％,2hPG：74.5％vs22.9％,HbA1c：52.9％vs29.9％,TC：59.2％vs37.6％,TG：58.6％vs 36.3％,HDL-C：69.4％vs43.3％,LDL-C：52.9％vs29.3％,BMI：42.7％vs38.9％.（2）糖尿病知识得分、运动和血糖监测次数与血糖不达标呈独立负相关.（3）不达标组颈动脉内膜-中层厚度（IMT）增厚发生率高于达标组;不达标组DR、糖尿病慢性肾脏疾病（CKD）发生率高于达标组.结论 长期综合管理可提高T2DM患者血糖达标率.血糖、BP、血脂和BMI不达标可增加糖尿病血管并发症的发生.

The target-influencing factor analysis of patients reaching the recommended targets of metabolic index diabetes after 6-year follow-up of intensive multifactorial intervention in patients with type 2 diabetes

Objective To investigate the proportion of patients who reached the recommended treatment targets of metabolic indexes T2DM during 6-year follow-up of after intensive multifactorial intervention,and to analyze the relative influencing factors.Methods 157 patients with newly onset T2DM received intensive multifactorial intervention and were followed-up periodically.Results （1） After 6-year follow-up of intensive multifactorial intervention,the levels of systolic blood pressure （SBP）,diastolic blood pressure（DBP）,FPG,2 hPG,HbA1c,TG,TC and LDL-C were significantly decreased while the HDL-C level was significantly increased and there was no significant difference in the BMI level.The rate of achievement targets at follow-up 6-year versus initial diagnosis were 75.2％ vs 52.9％ for SBP,66.9％ vs 40.8％ for DBP,61.8 vs 33.1％ for BP,59.2％ vs 19.7％ for FPG,74.5％ vs 22.9％for 2 hPG,52.9％ vs 29.9％ for HbA1c,59.2％ vs 37.6％ for TC,58.6％ vs 36.3％ for TG,69.4％ vs 43.3％ for HDL-C,52.9％ vs 29.3％ for LDL-C,42.7％ vs 38.9％ for body mass index （BMI） respectively.（2） Multiple logistic regression analysis showed that high scores of knowledge about diabetes,exercise and self-monitoring of blood glucose （SMBG） were correlated with achievement targets of blood glucose.（3） The prevalence of carotid artery intima-media thickening,chronic kidney disease （CKD） in diabetes and DR in treatment non-targeting group was significantly higher than in treatment targeting group （P＜0.05）.Conclusion long-term intensive multifactorial intervention is an effective therapy in improving glucose,BP,lipids targeting rate.High scores of knowledge about diabetes,exercise and SMBG can facilitate the achievement targets of blood glucose.The risk of diabetic angiopathy maybe increased in patients whose blood glucose,blood pressure,blood lipid and BMI do not reach the recommended targets.