年龄、性别和季节对门诊糖尿病患者血糖的影响

目的分析性别、年龄和季节变化对门诊糖尿病患者血糖控制的影响。方法回顾性分析2004至2011年我院内分泌科门诊17857例糖尿病患者糖化血红蛋白（HbAlc）检测结果。探索不同年龄段、性别以及不同月份门诊糖尿病患者的血糖变化规律。采用线性趋势检验和Cochran．Armitage趋势检验比较年度趋势变化。结果所有患者的平均年龄为（58±13）年，男女比为1．16：1，其HbAlc平均为7．1％±1．6％，其中HbAlc〈6．5％者占43．3％（3465／8000），HbAlc〈7．O％者占61．4％（4914／8000）。门诊糖尿病患者HbAlO由2004年的7．3％±1．7％降至2011年的6．8％±1．4％（F=24．17，P〈0．01）。患者HbAlc〈7．0％的比例从2004年55．3％增至2011年的69．0％（Z=4．83，P〈0．01）。2004至2011年患者血糖控制达标率（HbAlc〈7．0％）在≥40—60岁（Z=18．67，P〈0．01）和〉60岁（Z=5．58，P〈0．05）两个年龄段有明显改善，但在年龄〈40岁的患者无明显改善（Z=0．91，P〉0．05）。男性血糖控制达标率无显著改善（Z=2．61，P〉0．05），但女性血糖控制达标率明显提高（Z=28．10，P〈0．01）。2007年4～9月HbAlc水平和血糖控制达标率均较同年1～3月及10～12月差。结论内分泌科门诊糖尿病患者近8年血糖控制改善，40岁以上女性患者血糖控制较好，血糖控制存在季节性差异。要关注40岁以下男性糖尿病患者降糖治疗，可能需要根据季节变化调整降糖药物。

Effect of age, gender and season on blood glucose control in diabetic outpatients

Objective To assess the effects of gender, age and seasonal variation on glycemic control in outpatient diabetics. Methods The glycosylated hemoglobin Alc （HbA1 c） records of 17 857 cases from outpatients in the China-Japan Friendship Hospital enrolled from 2004 to 2011 was analyzed retrospectively, and the blood control status were compared among age groups, genders and seasons. Linear- contrast one-way analysis of variance and Cochran-Armitage analysis were applied to explore annual trend of glycemic control. Results The mean age of the subjects was （58 -＋ 13 ）yrs, the male-female ratio was 1.16：1 ; the mean HbAlc level was 7.1% ＋ 1.6% , and the HbAlc level in 3465 cases（43.3% ） was 〈 6.5% , and was 〈 7.0% in 4914 cases（61.4% ）. The HbAlc level declined significantly from 2004 to 2011 （7.3% ＋ 1.7% to 6. 8% ~ 1.4%, F =24. 17, P 〈0. O1 ） in those diabetic outpatients. More subjects achieved a HbAlc targets 〈7.0% in 2011 than in 2004 （69.0% vs 55.3%, Z =4. 83, P 〈0. O1 ）. The percentages of subjects reached a HbAlc targets of 〈 7.0% in patients aged ~〉40-60 yrs and 〉 60 yrs increased significantly from 2004 to 2011 （Z = 18.67, S. 58, all P 〈 0. 05）. The blood glucose control improved significantly in female patients through the years（Z = 28. 10, P 〈 0. 01 ）, but not in male subjects （Z ---2. 61, P 〉0. 05）. The standard-reaching rate of blood glucose in April to September was much lower than those in the other months in 2007. Conclusions Glycemic control is improved in the diabetic outpatients through the 8 years, and the blood glucose is controlled better in female patients aged over 40 years. There are seasonal differences in blood glucose control, more attention should be paid to the glycemic control in male patients below 40 years of age, and the therapeutic regimen could be adjusted with the seasons if needed.