上海市石化社区离退休职工2型糖尿病患者血糖控制相关因素分析

目的探讨社区离退休职工2型糖尿病(T2DM)患者血糖控制不良相关因素,为该人群血糖控制及并发症的防治提供依据。方法采用整群抽样方法,选取上海市石化社区离退休职工T2DM患者810例,按照血糖控制情况分为三组:理想控制组(n=153)、一般控制组(n=303)、控制不良组(n=354),测量身高、体重、血压、腰围和臀围,检测空腹血糖(FPG)、糖化血红蛋白(HbA1C)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等生化指标,采用问卷调查的方法调查家族史、病程、血糖检测的规律性、用药情况、饮食及运动情况等一般指标,采用多因素非条件Logistic回归分析血糖控制不良相关因素。结果各组间性别差异无统计学意义,但合并理想控制组与一般控制组作为一组,与控制不良组相比,前者女性患者比例更高,差异有统计学意义(P<0.05)。与理想控制组相比,一般控制组年龄较高,控制不良组病程较长,差异均有统计学意义(P<0.01)。与理想控制组比较,一般控制组和控制不良组TC、TG、LDL-C水平均显著升高,HDL-C水平显著降低,收缩压水平显著升高,血脂异常及肥胖患病率均显著升高,体力活动的强度显著降低,使用降糖药的个数显著增多,差异均有统计学意义(P<0.05,P<0.01)。但体力活动的时间以及饮食过量的发生率在三组之间差异无统计学意义(P>0.05)。多因素非条件Logistic回归分析显示,血糖控制不良的主要危险因素包括女性、年龄>65岁、初诊糖尿病时的血糖水平>7.8mmol/L、病程>10年、腹型肥胖、血脂异常、高血压、血糖检测不规律和运动强度过低(OR值分别为2.331、1.581、4.227、1.691、3.222、2.263、1.766、1.920和1.804)。结论女性、高龄、初诊糖尿病时的血糖水平高、肥胖、血脂异常、高血压、血糖检测不规律和运动强度过低等为中老年T2DM患者血糖控制不良的主要危险因素。

Analysis of Related Factors for Glycemic Controlling in Retired Workers with Type 2 Diabetes in a Petrochemical Community of Shanghai

Objective To investigate related factors for poor glycemic control in retired workers with type 2 diabetes （T2DM） in a petrochemical community of Shanghai. Methods A total of 810 patients （343 men, 467 women） with T2DM were recruited with cluster sampling method. These participants were divided into three groups according to glycemic control： ideal control group 4.4 mmol/L≤fasting plasma glucose （FPG） ≤6.1 mmol/L or glycated hemoglobin Alc （HbAIC）〈6.5%, n=153], general control group （6.1 mmol/L 〈FPG ≤ 7.0 mmol/L or 6.5% ≤ HbAIC ≤ 7.5%, n=303 ） and poor control group （FPG〉7.0 mmol/L or HbAIC〉7.5%, n=354）. Clinical data, such as body height, body weight, blood pressure, waist circumference, hip circumference, FPG, HbAlc, serum total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C） and other biochemical markers were measured, and family history, disease course （years）, the regularity of plasma glucose measure, medication, diet and the dose of exercise were surveyed with a standard questionnaires. Then related factors for poor glycemic control were analyzed. Results Compared with the ideal control group, participants in the general control group were older, and those in poor control group had longer disease course and those in both groups had less physical activities. There were no significant differences on gender between the three groups. After combined the ideal control group and the general control group as one group （group A）, the ratio of female participants in group A were higher than that in the poor control group （P〈0.05）. Compared with the ideal control group, the levels of systolic blood pressure （SBP）, FPG, TC, TG and LDL-C were significantly higher while HDL-C level was significantly lower in participants of the poor control group and the general control group. In addition, participants in the poor control group had higher prevalence of dyslipidemia, hypertension and obesity, and lower frequency of glycemic measure, therefore they received more drugs. Multiple Logistic regression analysis showed that： the major risk factors for poor glycemic control of retired workers with T2DM included female, age〉65 years, original plasma glucose level〉7.8 mmol/L, disease course〉10 years, abdominal obesity, dyslipidemia, hypertension, irregular glycemic measure and lower exercise intensity （OR=2.331, 1.581, 4.227, 1.691, 3.222, 2.263, 1.766, 1.920 and 1.804, respectively）. Conclusion Female, aging, higher original plasma glucose level, obesity, dyslipidemia, hypertension, irregular glycemic measure and lower exercise intensity were major risk factors for poor control of the middle-aged with T2DM.