某区社区管理2型糖尿病控制情况及其影响因素
Cross-Sectional Study on Type 2 Diabetes Mellitus Control and Influencing Factors in Community Management in a District of Shanghai
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摘要:
目的 通过以上海市某区社区管理2型糖尿病患者为基础的横断面研究,分析社区管理2型糖尿病控制情况及其影响因素。 方法 采用系统抽样方法,抽取上海市某区10个社区在册管理的735例2型糖尿病患者,采用问卷调查、体格检查和实验室检查相结合的方法,分析患者综合管理现状和血糖控制情况。并采用多因素logistic 回归分析血糖控制的影响因素。 结果 患者血糖控制理想率(HbA1c < 6.5%)为23.7%;血压控制理想率(<130/80 mmHg)为18.0%;总胆固醇、三酰甘油、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇控制理想率分别为34.0%、57.1%、42.3%和25.0%;体质指数(BMI)和腰臀比(WHR)控制理想率分别为40.5%和37.3%。病程(H=27.976,P<0.05)和胰岛素使用(H=10.953,P<0.05)是影响患者血糖控制的重要因素;在调整性别、年龄、病程和药物使用等混杂因素后,影响血糖控制的主要因素包括:患者BMI 控制水平(aOR=1.437,95% CI:1.002~2.060)和WHR控制水平(aOR=1.417,95% CI:1.031~1.948)、随访时间(aOR=1.016,95% CI:1.007~1.025)和随访的规范性(aOR=0.107,95% CI:0.074~0.153)等。 结论 该区社区管理2型糖尿病患者血糖、血压和血脂控制不够理想;影响患者血糖控制的主要因素包括:病程、胰岛素使用、体质指数、腰臀比和社区随访的规范性。 Abstract:Objective To evaluate the level of diabetic control in patients with type 2 diabetes mellitus in a community management system, and to identify potential influencing factors. Methods A cross-sectional study was conducted among 735 registered patients with type 2 diabetes mellitus from 10 communities of a district through a systematic sampling method. Questionnaires, physical examinations, and biochemical tests were performed to evaluate overall management level and glycemic control. A multivariate logistic regression analysis was used to identify potential influencing factors of glycemic control. Results The percentages of patients achieving ideal control were 23.7% for HbA1c (<6.5%), 18.0% for blood pressure (<130/80 mmHg), 34.0% for total cholesterol (TC), 57.1% for triglyceride (TC), 42.3% for high density lipoprotein cholesterol (HDL-C), 25.0% for low density lipoprotein cholesterol (LDL-C), 40.5% for body mass index (BMI), and 37.3% for waist-to-hip ratio (WHR). The results of K-W test showed that diabetes duration (H=27.976, P<0.05) and insulin use (H=10.953, P<0.05) were associated with glycemic control. Adjusted for confounders such as gender, age, duration, and drug use, the results of multivariate analysis showed BMI (aOR=1.437, 95% CI: 1.002-2.060), WHR (aOR=1.417, 95% CI: 1.031-1.948), the time length of follow-up (aOR=1.016, 95% CI: 1.007-1.025), and the normalization of follow-up (aOR=0.107, 95% CI: 0.074-0.153) were the potential influencing factors. Conclusion Among the patients with type 2 diabetes in the community management system, the control levels of hyperglycaemia, hypertension, and hyperlipidemia are not satisfactory. Factors that may influence glycemic control include duration, insulin use, BMI, WHR, and normalization of follow-up.
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