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马来西亚公立医院的糖尿病控制与并发症

Diabetes control and complications in public hospitals in Malaysia.

作者信息

Mafauzy M

机构信息

Diabcare-Malaysia Study Group, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.

出版信息

Med J Malaysia. 2006 Oct;61(4):477-83.

Abstract

The Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in public hospitals in Malaysia and compare to a similar study done in 1998. A total of 19 public hospitals participated in this study from which a total of 1099 patients were included and analysed. The majority of patients (94.8%) had type 2 diabetes mellitus and 66.5% were overweight or obese. As for glycaemic control only 41.0% of the patients had HbA1c < 7% and 18% had FPG < 6.1 mmol/L. As for lipid levels, only 32.0% of the patients had total cholesterol < 4.8 mmol/L; 59.6% had HDL-cholesterol > 1.1 mmol/L and 51.1% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia, only 52.8% of the patients were on lipid lowering therapy. As for blood pressure, 15.0% of the patients had blood pressure < 130/80 mmHg. Although 75.9% of the patients were on antihypertensive medication only 11.3% had blood pressure < 130/80 mmHg. Only 54.8% of patients admitted to adhering to a diabetic diet regularly and 38.9% exercised regularly. As for glucose monitoring, only 26.8% of the patients did home blood glucose monitoring and 1.8% did home urine glucose testing. There was also a high complication rate with the commonest being neuropathy (19.0%) followed by albuminuria (15.7%), background retinopathy (11.1%) and microalbuminuria (6.6%). Compared to the 1998 study, there was some improvement in the percentage of patients achieving target levels and a reduction in the prevalence of complications. In conclusion, the majority of diabetic patients treated at the public hospitals were still not satisfactorily controlled and this was still associated with a high prevalence of complications. There is still an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.

摘要

“亚洲糖尿病关怀”项目旨在研究亚洲糖尿病护理状况及糖尿病并发症患病率,本研究旨在评估马来西亚公立医院的上述情况,并与1998年进行的类似研究作比较。共有19家公立医院参与了本研究,共纳入并分析了1099例患者。大多数患者(94.8%)患有2型糖尿病,66.5%超重或肥胖。在血糖控制方面,只有41.0%的患者糖化血红蛋白(HbA1c)<7%,18%的患者空腹血糖(FPG)<6.1 mmol/L。在血脂水平方面,只有32.0%的患者总胆固醇<4.8 mmol/L;59.6%的患者高密度脂蛋白胆固醇(HDL-胆固醇)>1.1 mmol/L,51.1%的患者甘油三酯<1.7 mmol/L。尽管血脂异常患者比例较高,但只有52.8%的患者接受降脂治疗。在血压方面,15.0%的患者血压<130/80 mmHg。虽然75.9%的患者服用抗高血压药物,但只有11.3%的患者血压<130/80 mmHg。只有54.8%的患者承认定期坚持糖尿病饮食,38.9%的患者定期锻炼。在血糖监测方面,只有26.8%的患者进行家庭血糖监测,1.8%的患者进行家庭尿糖检测。并发症发生率也很高,最常见的是神经病变(19.0%),其次是蛋白尿(15.7%)、背景性视网膜病变(11.1%)和微量白蛋白尿(6.6%)。与1998年的研究相比,达到目标水平的患者百分比有所改善,并发症患病率有所降低。总之,在公立医院接受治疗的大多数糖尿病患者仍未得到满意控制,这仍与高并发症患病率相关。迫切需要对患者和医护人员进行教育,使其了解实现临床目标的重要性,并且必须做出更大努力来实现这些目标。

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