| 摘要: |
| 目的 分析长期在我院门诊就诊的2型糖尿病（type 2 diabetes mellitus，T2DM）患者糖代谢指标的控制现状，为更好地管理患者血糖提供理论依据。方法 于2012年3月1日至4月30日间采用现况调查方式收集304例T2DM患者近3个月的临床及实验室资料，根据降糖治疗方案将患者分为单纯口服降糖药物治疗组（A组）、单纯胰岛素治疗组（B组）和口服药联合胰岛素治疗组（C组），评估各项代谢指标的控制现状及与并发症和合并症的关系。结果 （1）304例患者平均糖化血红蛋白（hemoglobin A1c，HbA1c）为（8.01±1.14）%，达标率（<7.0%者）为13.16%；74.67%（227/304）的患者至少合并1种并发症或伴随疾病，确诊时的餐后2 h血糖（postprandial glucose，PPG）与合并大血管病变的数目相关（r=0.131，P<0.05）。（2）B组和C组的糖代谢控制情况明显好于A组（P均<0.05），磺脲类和双胍类药物仍为常用降糖药物，常用的胰岛素治疗方案是预混胰岛素类似物（30/59，50.85%）和每日4次胰岛素强化治疗（16/59，27.12%）。（3）各组患者填表前1周自测血糖者分别占27.56%、57.63%和50.85%，且HbA1c、空腹血糖（fasting blood glucose，FBG）和PPG的控制情况均好于同组未自测血糖者（均P<0.01）。（4）Logistic回归分析显示自测血糖为患者血糖不达标（即HbA1c ≥7%）的影响因素（OR值为0.379，P<0.01）。结论 HbA1c达标率低仍是糖尿病治疗中的棘手问题，血糖控制不佳者，应积极调整治疗方案，包括及时启用胰岛素治疗和积极调整胰岛素用量。 |
| 关键词: 2型糖尿病 门诊患者 糖基化血红蛋白A 控制现况 |
| DOI：10.3724/SP.J.1008.2014.00852 |
| 投稿时间：2014-04-09修订日期：2014-05-28 |
| 基金项目:国家自然科学基金面上项目（30871198），上海市自然科学基金（12ZR1438100）. |
|
| Analysis of glycemic control indices in 304 diabetic patients |
| CHEN Jin,YANG Lu,CHEN Jing-bo,DING Chang-hua,LU Jian-can,HUANG Xiang-qin,HUANG Qin* |
| (Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Objective To analyze the controlling status of glucose metabolic indices of outpatients with type 2 diabetes mellitus (T2DM) who were treated in our hospital for a long term, so as to provide theoretical evidence for better management of the blood glucose. Methods From March 1, to April 30, 2012, the clinical and laboratory data of the latest 3 months of 304 T2DM patients were collected. According to the hypoglycemic therapies, the patients were divided into oral hypoglycemic drug treatment group (group A), pure insulin treatment group (group B), and oral medicine combined with insulin treatment group (group C). The status of metabolism indices and the relationship between the controlling status of metabolic indices and complications were explored. Results (1) The mean hemoglobin A1c (HbA1c) of the 304 T2DM patients was (8.01±1.14)%, with only 13.16% of them reaching the recommended glycemic level (<7.0%). We also found that 74.67%(227/304) of patients had at least one complication or concomitant disease. The 2 h-postprandial glucose at diagnosis was found correlated with the number of macrovascular diseases (r=0.131,P=0.024). (2) The glycemic control in group B and C was significantly better than that in group A (all P<0.05). Sulphonylureas and biguanides were still the most commonly used hypoglycemic agents. Premix insulin analog (accounting for 50.85%, 30/59) and intensive insulin therapy (accounting for 27.12%, 16/59) were the commonly used insulin therapy. (3) Patients who performed self-monitoring of blood glucose (SMBG) a week before filling our form in group A, B, and C accounted for 27.56%, 57.63% and 50.85%, respectively. And the control of glycosylated HbA1c, fasting blood glucose and postprandial glucose of these performing SMBG was better than those not performing in the same group (P<0.01 for all). (4) Logistic regression analysis indicated that performing SMBG was an influencing factor (OR=0.379,P=0.007) of poor glycemic control (glycosylated hemoglobin A1c ≥7%). Conclusion Poor control of glycosylated HbA1c remains to be a great challenge for treatment of diabetes. Treatment strategy should be adjusted promptly when glycemic control fails to achieve the recommended level, including starting insulin therapy and adjusting amount of insulin amount. |
| Key words: type 2 diabetes mellitus outpatients glycosylated hemoglobin A control status |
