社区2型糖尿病患者自我管理水平与糖尿病视网膜病变的相关性研究

目的探讨社区人群2型糖尿病(type 2 diabetes mellitus,T2DM)患者自我管理相关行为与糖尿病视网膜病变(diabetic retinopathy,DR)的关系。方法 2012年4—5月在苏州市金阊区随机抽取四个街道社区,招募社区T2DM患者,患者在签订知情同意书的前提下被纳入调查。由经过培训的调查员采用统一设计的调查表,收集并记录调查对象的人口统计学特征、生活行为方式、病程、家族史、DM微血管并发症等资料。正态分布资料用x珋±s表示,两组间的比较用t检验;非正态分布资料用中位数(四分位数间距)表示,两组间比较用Wilcoxon秩和检验;计数资料用率表示,两组间的比较用χ2检验。采用Logistic回归模型分析自我管理水平与DR的相关性。检验水准α=0.05,P0.05为差异有统计学意义。结果 887例患者中,有34.3%的患者HbA1c控制达标。有DR的T2DM患者比无DR的T2DM患者具有更长的病程[7(3~11)年vs.5(2~9)年]、更高的收缩压[(140.0±16.1)mm Hg(1mmHg=0.133kPa)vs(137.0±16.9)mm Hg]、更高的空腹血糖(8.01±2.73)mmol/L vs(7.57±2.30)mmol/L)和HbA1c水平[(7.84±1.40)%vs.(7.53±1.31)%]。多因素Logistic回归分析结果表明,与HbA1c未达标者相比,HbA1c达标者合并DR的危险性显著降低,其OR(95%CI)为0.63(0.44~0.91)。结论 HbA1c达标是T2DM患者合并DR的保护因素,控制血糖并使其达标是防止T2DM患者合并DR的关键。

Correlation between self-management level and diabetic retinopathy among patients with type 2 diabetes mellitus in community

Objective To explore the relationship between self- management level and diabetic retinopathy （DR） among patients with type 2 diabetes mellitus （T2DM） in community. Methods Patients with T2DM from 4 communities of Jin- chang district of Suzhou city were enrolled in this study from April to May in 2012 after they signed the informed consent. The trained investigators used a standard questionnaire to collect the data on demographic characteristics, living behaviors, course of disease, family history, and microvascular complications of DM. Data of normal distribution were represented by ± s, t test was used for comparison between groups ; data without normal distribution were represented by median, Wilcoxon Rank sum test was used for comparison between groups; count data were represented by rate, X2 test was used for compari- son between groups. Logistic regression model was used to analyze the correlation between self- management level and DR. For a significance level of α = 0. 05, P 〈 0.05 was considered statistically significant. Results Of 887 cases, 34.3% had achieved an ideal level of HbAlc. Patients with DR tended to have a longer duration of diabetes [7（3 - 11 ）vs. 5（2 -9） year], a higher systolic blood pressure（ 140.0 ± 16.1 vs. 137.0 ± 16.9 mm Hg） and higher levels of fasting blood glucose （ 8.01 ± 2.73 vs. 7.57 ± 2.30 mmol/L） and HbA1 c （ 7.84 ± 1.40 vs. 7.53 ± 1.31% ）. Muhivariable logistic regression a- nalysis showed that compared with patients had not achieved a normal level of HbAlc, those who had a normal level of HbAlc were lower risks for DR, OR = O. 63 （95% （7/：0.44 - 0.91 ）. Conclusions For ＇r2DM patients, the control of HbAI c to a normal lever may be an important protective factor to prevent DR. This study suggests that the control of blood sugar to the normal is the key to the prevention of DR in patients with T2DM.