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目的了解并分析上海市沪东社区45~59岁年龄段人群糖尿病的社区综合管理现况。方法选取2013年10月—2014年5月间上海市沪东社区卫生服务中心45~59岁的常住人口为调查对象。按照整群抽样原则抽取上海市沪东社区33个居民委员会中的8个,共纳入1 104例。本研究由问卷调查(性别、年龄等)、体格检查(血压、体质量)和实验室检测(血糖、血脂等)组成。依据《中国2型糖尿病防治指南》(2013版)的社区综合控制目标进行评判。结果本研究最终纳入1 018例,糖尿病患病率为12.38%,知晓率为73.81%。女性糖尿病患者空腹血糖及糖化血红蛋白达标率分别为24.7%和41.1%,均低于男性,差异有统计学意义(P<0.05)。糖尿病患者的血压、血脂、体质量的社区控制达标率男性和女性间差异无统计学意义。随着体质量的增高,糖尿病患病率随之增高(P<0.01)。糖尿病前期的患者中,男性的吸烟率高于女性,差异有统计学意义。将被调查人群分为非糖尿病组、糖尿病前期组以及糖尿病组,Cochran-Armitage趋势检验显示,吸烟率有逐步增高趋势,而体质量达标率逐步下降,差异均有统计学意义(P<0.01)。结论本社区中年人群糖尿病女性患者的空腹血糖管理有待提高。糖尿病前期占13.06%,对吸烟、超重等不良生活方式的干预有待进一步加强。提示社区全科医生应在结合国内外指南的基础上,将糖尿病一级预防的契入点提前,早期关注糖尿病前期患者、干预相关危险因素,促进有效的糖尿病社区管理。
Objective To understand and analyze the status of community integrated management of diabetes in 45-59-year-old Shanghai Hudong community. Methods From October 2013 to May 2014, the resident population from 45 to 59 years old in Shanghai Hudong Community Health Service Center was selected as the survey object. According to the principle of cluster sampling, eight out of 33 neighborhood committees in Shanghai Hudong community were sampled and 1 104 cases were included. This study was composed of questionnaires (gender, age, etc.), physical examination (blood pressure, body mass) and laboratory tests (blood glucose, blood lipids, etc.). According to the “Guide to Prevention and Treatment of Type 2 Diabetes in China” (2013 version) community comprehensive control objectives for evaluation. Results The study finally included 1 018 cases, the prevalence of diabetes was 12.38%, the awareness rate was 73.81%. The compliance rates of fasting blood glucose and glycosylated hemoglobin in female patients with diabetes were 24.7% and 41.1%, respectively, which were lower than those in men (P <0.05). There was no significant difference between male and female in blood pressure, blood lipid and body mass control rate of diabetic patients. With the increase of body weight, the prevalence of diabetes increased (P <0.01). In pre-diabetes patients, the smoking rate in males was higher than that in females, the difference was statistically significant. The Cochran-Armitage trend test showed that smoking prevalence increased gradually, but body mass compliance rate decreased gradually, the differences were statistically significant (P <0.01) . Conclusion The fasting blood glucose management of diabetic women with middle-aged population in this community needs to be improved. Pre-diabetes accounted for 13.06% of smoking, overweight and other unhealthy lifestyle intervention to be further strengthened. It is suggested that community GPs should combine advancement with domestic and international guidelines to advance the detention point of primary prevention of diabetes, early attention to patients with pre-diabetes, intervention of relevant risk factors and promote effective community management of diabetes.