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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。
Objective To investigate the related factors of poor glycemic control in retired workers with type 2 diabetes mellitus (T2DM) in community and provide the basis for the prevention and control of blood sugar in this population. Methods A total of 810 T2DM patients from rehabilitated workers in Shanghai Petrochemical Community were enrolled in this study. Patients were divided into three groups according to their glycemic control: ideal control group (n = 153), general control group (n = 303), poor control group (HbA1C), serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured by questionnaires. The family history, duration of disease, regularity of blood glucose test, medication, diet and exercise were investigated by questionnaire. Factor non-conditional Logistic regression analysis of factors related to poor glycemic control. Results There was no significant difference in sex between the groups. However, the combination of the ideal control group and the general control group was a group. Compared with the poor control group, the proportion of female patients in the former group was significantly higher (P <0.05). Compared with the ideal control group, the general control group was older and the control group had a longer course of disease, the differences were statistically significant (P <0.01). Compared with the ideal control group, the levels of TC, TG and LDL-C in the general control group and the poorly controlled group were significantly increased, the HDL-C level was significantly decreased, the systolic blood pressure level was significantly increased, the prevalence of dyslipidemia and obesity were significantly increased High, physical activity intensity was significantly reduced, the number of hypoglycemic agents significantly increased, the difference was statistically significant (P <0.05, P <0.01). However, the time of physical activity and the incidence of overdose in the three groups showed no significant difference (P> 0.05). Multivariate non-conditional logistic regression analysis showed that the main risk factors of poor glycemic control included female, age> 65 years old, blood glucose level> 7.8mmol / L in newly diagnosed diabetes, duration of disease> 10 years, abdominal obesity, dyslipidemia, , Irregular blood glucose test and exercise intensity (OR = 2.331, 1.581, 4.227, 1.691, 3.222, 2.263, 1.766, 1.920 and 1.804 respectively). Conclusions Female, elderly, high blood sugar level, obesity, dyslipidemia, hypertension, irregular blood glucose test and low exercise intensity are the main risk factors for poor glycemic control in middle-aged and elderly patients with T2DM.