超重或肥胖2型糖尿病患者降糖药物治疗与血糖控制现况分析

目的评估超重或肥胖2型糖尿病患者血糖的控制达标情况及降糖药物治疗的现状。方法选取2012年1-3月中山市244例超重或肥胖2型糖尿病患者，根据2010年版《中国2型糖尿病防治指南》横断面评估其血糖、血压达标情况，分析患者降糖药物使用及大血管并发症情况。结果244例患者中糖化血红蛋白（HbA。c）达标率为35％，空腹及餐后血糖控制达标率比例分别为26％、40％。患者血压得到较好的控制率46．7％。患者降糖药物治疗中未使用药物5例（2．0％）、单用二甲双胍或使用二甲双胍及一种口服降糖药38例（15．6％）、单用一种口服降糖药或使用两种口服降糖药（不包括二甲双胍）38例（15．6％）、使用三种或以上口服降糖药21例（8．6％）、使用胰岛素及口服降糖药（不包括用双胍类）93例（38．1％）、使用胰岛素及含双胍类降糖药49例（20．1％）。244例患者中联合使用双胍类97例（39．7％）、联合胰岛素治疗142例（58．2％），胰岛素治疗在治疗方案中占比例大，双胍类治疗占比例少。联合胰岛素治疗组HbA1c较口服药物治疗组高，联合二甲双胍治疗组HbA1c较无使用二甲双胍组高。结论我市超重或肥胖2型糖尿病患者血糖控制达标率稍高于全国水平，但不达标率仍很高，应重视超重及肥胖2型糖尿病患者的强化降糖治疗。

Survey on status of blood glucose control and hypoglycemic agents treatment in overweight or obese type 2 diabetes patients.

Objective To assess the status of blood glucose control and hypoglycemic agents treatment in overweight or obese type 2 diabetic patients. Methods This survey recruited 244 overweight or obese type 2 diabetic patients randomly in the People＇s Hospital of Zhongshan from Jan. 2012 to Mar. 2012. According to the Chinese Guideline on Prevention and Treatment of Type 2 Diabetes, a cross-sectional investigation was performed to evaluate the targeted status of HbA~o and blood pressure. Hypoglycemic agent protocols and occurrence of macrovascular complications were analyzed simultaneously. Results 35% of the patients targeted HbA,o 7.5%, while 26% and 40% of patients got well control in fasting and postprandial plasma glucose respectively. 46.7% of patients reached good blood pressure control. For therapeutic protocols, 5 patients （2.0%） did not use antidiabetie drugs, 38 （15.6%） used metformin only or metformin combined with one kind of oral antidiabetic drugs, 38 （15.6%） applied one or two kinds of oral antidiabetic drugs without metformin, 21 （8.6%） took more than three kinds of oral antidiabetic drugs, 93 （38.1%） took insuline and oral antidiabetic drugs without meformine, and 49 （20.1%） used insuline and metformin. Of the 244 patients, 97 （39.7%） patients used metformin, while 142 （58.2%） patients used insulin. The ordinal ratio of antidiabetic drugs consumption was higher for insulin, followed by metformin. We could see that HbA~ were higher in the insulin group than the oral antidiabetic drugs group, and HbA1c were higher in use with metformin than without metformin. Conclusion The targeted rate of blood glucose control in our survey is a little higher than results from national survey, but there have been still more patients far from the guiding standard. We should attach importance to the strengthening of the overweight and obese patients with type 2 diabetes hypoglycemic therapy.