某社区中年人群糖尿病患者综合管理现况与分析

目的 了解并分析上海市沪东社区45~59岁年龄段人群糖尿病的社区综合管理现况。 方法 选取2013年10月—2014年5月间上海市沪东社区卫生服务中心45~59岁的常住人口为调查对象。按照整群抽样原则抽取上海市沪东社区33个居民委员会中的8个,共纳入1 104例。本研究由问卷调查(性别、年龄等)、体格检查(血压、体质量)和实验室检测(血糖、血脂等)组成。依据《中国2型糖尿病防治指南》(2013版)的社区综合控制目标进行评判。 结果 本研究最终纳入1 018例,糖尿病患病率为12.38%,知晓率为73.81%。女性糖尿病患者空腹血糖及糖化血红蛋白达标率分别为24.7%和41.1%,均低于男性,差异有统计学意义(P<0.05)。糖尿病患者的血压、血脂、体质量的社区控制达标率男性和女性间差异无统计学意义。随着体质量的增高,糖尿病患病率随之增高(P<0.01)。糖尿病前期的患者中,男性的吸烟率高于女性,差异有统计学意义。将被调查人群分为非糖尿病组、糖尿病前期组以及糖尿病组,Cochran-Armitage趋势检验显示,吸烟率有逐步增高趋势,而体质量达标率逐步下降,差异均有统计学意义(P<0.01)。 结论 本社区中年人群糖尿病女性患者的空腹血糖管理有待提高。糖尿病前期占13.06%,对吸烟、超重等不良生活方式的干预有待进一步加强。提示社区全科医生应在结合国内外指南的基础上,将糖尿病一级预防的契入点提前,早期关注糖尿病前期患者、干预相关危险因素,促进有效的糖尿病社区管理。 

The investigation and analysis of comprehensive management in middle aged diabetes mellitus in a Shanghaibased community

Objective To reveal and analyze the current situation of comprehensive management among 45 to 59 years diabetes mellitus in Hudong community. Methods From October, 2013 to May, 2014, we selected permanent residents aged 45 to 59 as subjects from Shanghai Hudong community service center. According to the principle of cluster sampling, the survey was conducted 8 from 33 neighborhood committees, thus it enrolled altogether 1 104 subjects. The study included questionnaire survey (gender, age etc), physical examination (body mass index, blood pressure) and laboratory exanimation (blood glucose, blood lipid etc). We judged the subjects by comprehensive control target based on the "Chinese type 2 diabetes prevention guides (2013 Edition) ". Results The study finally enrolled 1 018 subjects. The prevalence of diabetes was 12. 38% and the awareness rate was 73. 81%. The compliance rate of Fasting blood glucose and glycosylated hemoglobin in female were both lower than those in male, and the differences were statistically significant (P < 0. 05). The compliance rate of combined hypertension, blood lipid and body mass index had no difference in different genders. With the increasing of BMI, the prevalence of diabetes mellitus also increased, with statistical significance (P < 0. 01). The smoking rate was higher in male than that in female among pre-diabetic group, and the difference was statistically significant. We divided the subjects as non diabetic group, pre-diabetic group and diabetic group, and analyzed by Cochran-Armitage trend test, then found that the smoking rate gradually increased, while the compliance rate of BMI gradually decreased, and the difference was statistically significant (P < 0. 01). Conclusion We need to improve the management rate of fasting blood glucose in middle aged female diabetic patients in our community. The Prevalence of pre-diabetic was 13. 06%, and we need to strengthen the intervention of unhealthy lifestyle such as smoking and overweight among them.Our investigation indicated that the primary prevention of diabetes mellitus should be stricter. In order to promote effective community management based on the guideline both domestic and abroad, general practitioners should pay more attention to pre-diabetics, and intervention of related risk factors.