Schiel R, Hoffmann A, Müller U A
Klinik für Innere Medizin II, Friedrich-Schiller-Universität Jena.
Med Klin (Munich). 1999 Mar 15;94(3):127-32. doi: 10.1007/BF03044841.
In a population based study the quality of diabetes care of insulin-treated diabetic patients aged 16 to 60 years and living in a rural area was studied. The parameters of metabolic control as well as the incidence of acute complications (severe hypoglycemia with the need of glucose or glucagon injection, ketoacidosis with hospital admission) were assessed by examination and with a standardized questionnaire in 81% of the target population (type-1/type-2-diabetic patients: n = 25/33). Also, in all the patients diabetic long-term complications (retinopathy, nephropathy, amputations of the lower extremities) were examined. 76% of the patients with type-1-diabetes and 91% of the patients with type-2-diabetes mellitus completed standardized questionnaires to assess quality of life and treatment satisfaction.
In type-1-diabetic patients HbA1c was 9.38 +/- 1.6%. In type-2-diabetic patients it was 9.53 +/- 1.91%. None of the patients examined was regularly treated by a specialized physician/diabetologist. The goal of metabolic control, a HbA1c value below 7.2%, was reached only by 4% of the patients with type-1-and 12% of the patients with type-2-diabetes mellitus. In multivariate analysis the most important factor associated with HbA1c was in type-1-diabetic patients female sex (R-squared = 0.17, c = 0.38, p = 0.059); in patients with type-2-diabetes mellitus it was the number of insulin injections per day (R-squared = 0.37, c = 0.19, p = 0.0096). All other factors investigated in the model (diabetes duration, insulin dosage/kg body weight, frequency of blood- or urine-glucose self-monitoring/week, body mass index, educational level) showed no significant associations. Quality of life and treatment satisfaction of the patients were good and comparable to other trials.
Out of other studies there is evidence for better metabolic control in patients regularly treated by specialized physicians/diabetologists and in patients who participated in structured treatment and teaching programs. These features must be the main goals of treatment for all patients with diabetes mellitus.
在一项基于人群的研究中，对年龄在16至60岁、居住在农村地区且接受胰岛素治疗的糖尿病患者的糖尿病护理质量进行了研究。通过检查以及标准化问卷，对目标人群中81%的患者（1型/2型糖尿病患者：n = 25/33）的代谢控制参数以及急性并发症（需要注射葡萄糖或胰高血糖素的严重低血糖、因酮症酸中毒入院）的发生率进行了评估。此外，还对所有患者的糖尿病长期并发症（视网膜病变、肾病、下肢截肢）进行了检查。76%的1型糖尿病患者和91%的2型糖尿病患者完成了标准化问卷，以评估生活质量和治疗满意度。
1型糖尿病患者的糖化血红蛋白（HbA1c）为9.38±1.6%。2型糖尿病患者的糖化血红蛋白为9.53±1.91%。接受检查的患者均未接受专科医生/糖尿病专家的定期治疗。只有4%的1型糖尿病患者和12%的2型糖尿病患者达到了代谢控制目标，即糖化血红蛋白值低于7.2%。在多变量分析中，与糖化血红蛋白相关的最重要因素在1型糖尿病患者中是女性（决定系数R² = 0.17，回归系数c = 0.38，p = 0.059）；在2型糖尿病患者中是每天的胰岛素注射次数（决定系数R² = 0.37，回归系数c = 0.19，p = 0.0096）。模型中研究的所有其他因素（糖尿病病程、每千克体重的胰岛素剂量、每周自我监测血糖或尿糖的频率、体重指数、教育水平）均未显示出显著关联。患者的生活质量和治疗满意度良好，与其他试验相当。
与其他研究相比，有证据表明接受专科医生/糖尿病专家定期治疗的患者以及参与结构化治疗和教学项目的患者代谢控制更好。这些特点必须成为所有糖尿病患者治疗的主要目标。
