北京市社区40岁以上2型糖尿病患者血糖达标率的调查研究

目的 了解北京市部分社区40岁以上2型糖尿病患者血糖达标率的现状.方法 2011年12月至2012年8月在北京的三个社区（古城社区、金鼎社区、老山社区）的卫生服务中心通过普查的形式对40岁以上人群19 470名进行2型糖尿病相关的调查.符合标准的2 534名居民接受问卷调查、体格检查、实验室检查[肝肾功能、血糖、血脂、糖化血红蛋白（HbA1c）]等项目.选择人群中问卷调查结果为2型糖尿病（T2DM）的居民,以HbA1c＜7％为达标标准对其进行血糖达标率的分析,组间比较采用t检验及方差分析,logistic回归模型分析与血糖达标率可能相关的因素.结果 共入选2 523例2型糖尿病患者,平均HbA1c为（7.4±1.8）％,其中血糖达标率为45.7％.调查中发现仅用口服降糖药组、仅用胰岛素组、胰岛素＋口服降糖药组的平均HbA1c分别为（7.4＋1.6）％、（7.9±2.2）％、（7.9±2.0）％,达标率分别是47.2％（568/1 203）、32.5％（87/268）、26.4％（73/276）;单药降糖、双药降糖以及3种以上降糖药物控制的患者的HbA1c分别为（7.3±1.5）％、（7.5±1.9）％、（7.5±1.2）％,血糖达标率分别为45.0％（472/1049）、39.6％ （149/376）、37.0％（20/54）.病程＜1年、1～5年、5～ 10年、≥10年的患者HbA1c分别为（7.0±1.5）％、（7.1±1.6）％、（7.4±1.8）％、（7.8±1.9）％,达标率分别为56.4％（195/346）、55.5％（422/760）、44.7％（266/595）、32.8％（270/822）.logistic回归分析结果显示女性、体质指数、腰臀比、收缩压、并发症/伴发症、糖尿病病程、治疗方案与HbA1c达标率呈现相关性（OR=1.320、0.762、0.027、0.992、1.264、0.431、0.432,均P＜0.05）.结论 社区40岁以上人群中T2DM患者血糖达标率不足一半.随着糖尿病病程的延长,糖尿病的达标率不断下降.

Investigation of glycemic control in the patients over 40 years old with type 2 diabetes in communities of Beijing

Objective To investigate the current status of the glycemic control in the patients aged 40 or older in the communities of Beijing.Methods Total of 19 470 people aged 40 years or older were enrolled to perform census in the present study from three communities,Gucheng,Jinding and Laoshan,of Beijing from December 2011 to August 2012.Each participant who met the standard received a questionnaire survey,physical examination and laboratory examination （liver and kidney function,serum lipid and hemoglobin glycosylated hemoglobin （HbA1c））.The glycemic control of the patient with type 2 diabetes mellitus（T2DM）,which is reported in the questionnaire,was assessed according to the goal of HbA1c 〈 7% advocated by the American Diabetes Association （ADA） and the Chinese Diabetes Society.The t test and ANOVA analysis was used to compare the difference between groups.A logistic regression analysis was made to reveal the characteristics associated with patients attaining HbA1c 〈 7.0%.Result Of the 2 523 patients with type 2 diabetes included in the survey,the mean HbA1c was （7.4 ± 1.8） % and patients who met the glycemic goal （HbA1c 〈 7%） was 45.7%.The oral antidiabetic drugs （OADS） monotherapy,insulin monotherapy,OAD＋Insulin groups had mean HbA1c levels of （7.4 ± 1.6）%,（7.9 ±2.2）% and （7.9 ± 2.0） %,respectively,and among those three groups,47.2% （568/1 203）,32.5% （87/268）,26.4% （73/276） of the patients met the goal of HbA1c 〈 7.0%.The mean HbA1 c of the patients,treated with oneOAD,twoOADsand more than three OADs,was （7.3±1.5）%,（7.5 ±1.9）% and （7.5± 1.2） %,respectively,while the percentage of patients who met the glycemic goal of HbA1c 〈 7.0% was 45.0% （472/1 049）,39.6% （149/376） and 37.0% （20/54）.As the development of the diabetes,the average of the HbA1c among patients with the duration of less than one year,1-5 years,5-10 years and more than 10 years was （7.0±1.5）%,（7.1±1.6）%,（7.4±1.8）% and （7.8±1.9）% and the nu