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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。
Objective To analyze the status of glycometabolism control in patients with type 2 diabetes mellitus (T2DM) who have long been hospitalized in our hospital and provide a theoretical basis for better management of patients’ blood glucose. Methods The clinical and laboratory data of 304 patients with T2DM during the recent 3 months from March 1 to April 30, 2012 were collected. Patients were divided into simple oral hypoglycemic drugs (Group A), simple insulin treatment group (group B) and oral medication combined insulin treatment group (group C) to evaluate the status of the control of each metabolic index and its relationship with complications and comorbidities. Results (1) The average hemoglobin A1c (HbA1c) was (8.01 ± 1.14)% in 304 patients and 13.16% in the standard rate (<7.0%). At least 74.67% (227/304) The postprandial 2 h postprandial glucose (PPG) at the time of diagnosis was associated with the number of macrovascular complications (r = 0.131, P <0.05). (2) The glycemic control in group B and group C was significantly better than that in group A (all P <0.05). The sulfonylureas and biguanides were still the commonly used antidiabetic drugs. The commonly used insulin regimen was the premixed insulin analogues (30/59, 50.85%) and 4 times daily insulin intensive treatment (16 / 59,27.12%). (3) Patients in each group had 27.56%, 57.63% and 50.85% respectively of the self-test blood glucose before the first week of filling, and the control of HbA1c, fasting blood glucose (FBG) and PPG were better than those in the same group Blood glucose test (all P <0.01). (4) Logistic regression analysis showed that self-measured blood glucose was the influencing factor (HbA1c≥7%) of patients with non-compliance (OR = 0.379, P <0.01). Conclusions The low compliance rate of HbA1c is still a thorny problem in the treatment of diabetes. Poor blood glucose control should be actively adjusted treatment options, including the timely activation of insulin therapy and actively adjust the amount of insulin.