北京三级医院 2 型糖尿病管理现状：指南与现实之间的差距。

Management status of type 2 diabetes mellitus in tertiary hospitals in Beijing: gap between guideline and reality.

机构信息

Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China.

出版信息

Chin Med J (Engl). 2012 Dec;125(23):4185-9.

Abstract

BACKGROUND

Diabetes has become one of the most common chronic diseases and the third leading cause of death in China. Many programs have been initiated at national and local levels to address the illness. However, the effect of these programs in daily outpatient clinics is still unclear. The objective of this study was to investigate the management status of type 2 diabetes mellitus (T2DM) and factors associated with it in diabetes clinics of tertiary hospitals in Beijing.

METHODS

A cross-sectional survey was conducted in six tertiary hospitals in Beijing. Control criteria were defined based on 2007 China guideline for type 2 diabetes (CGT2D).

RESULTS

A sample of 1151 patients, age (60.8 ± 9.2) years, and with a median disease duration of 7.3 years was included. The hemoglobin A1c (HbA1c) mean level was (7.15 ± 1.50)%, the percentage of patients achieving the targets for HbA1c was 37.8%, blood pressure 65.6%, triglyceride (TG) 48.8%, high-density lipoprotein (HDL) 59.2%, low-density lipoprotein (LDL) 34.0%, and total cholesterol (TC) 42.0%. The factors independently associated with glycemic control were diabetes duration (odds ratio (OR) = 0.95; 95% confidence interval (CI): 0.919 - 0.982, P < 0.01), body mass index (BMI) (OR = 0.914, 95%CI: 0.854 - 0.979, P = 0.01) and smoking (OR = 0.391, 95%CI: 0.197 - 0.778, P < 0.01). The factors independently associated with blood pressure control were BMI (OR = 0.915, 95%CI: 0.872 - 0.960, P < 0.01) and male gender (OR = 0.624, 95%CI: 0.457 - 0.852, P < 0.01). The factor independently associated with LDL control was education level (OR = 1.429, 95%CI: 1.078 - 1.896, P = 0.013).

CONCLUSIONS

The management status of T2DM patients in tertiary hospitals in Beijing has improved remarkably. However, there is still room for further improvement to reach the guideline target. Long diabetes duration, high BMI, smoking, male gender and low education level were independently associated with poor metabolic control.

摘要

背景

糖尿病已成为中国最常见的慢性病之一，也是导致死亡的第三大原因。国家和地方层面已经启动了许多项目来应对这一疾病。然而，这些项目在日常门诊中的效果尚不清楚。本研究旨在调查北京三级医院糖尿病门诊中 2 型糖尿病（T2DM）的管理现状及相关因素。

方法

本研究采用横断面调查方法，在北京 6 家三级医院进行。根据 2007 年中国 2 型糖尿病指南（CGT2D）定义了控制标准。

结果

共纳入 1151 例年龄（60.8±9.2）岁、中位病程 7.3 年的患者。糖化血红蛋白（HbA1c）平均水平为（7.15±1.50）%，HbA1c 达标率为 37.8%，血压达标率为 65.6%，三酰甘油（TG）达标率为 48.8%，高密度脂蛋白（HDL）达标率为 59.2%，低密度脂蛋白（LDL）达标率为 34.0%，总胆固醇（TC）达标率为 42.0%。与血糖控制相关的独立因素为糖尿病病程（比值比（OR）=0.95；95%置信区间（CI）：0.919-0.982，P＜0.01）、体质指数（BMI）（OR=0.914，95%CI：0.854-0.979，P=0.01）和吸烟（OR=0.391，95%CI：0.197-0.778，P＜0.01）。与血压控制相关的独立因素为 BMI（OR=0.915，95%CI：0.872-0.960，P＜0.01）和男性（OR=0.624，95%CI：0.457-0.852，P＜0.01）。与 LDL 控制相关的独立因素为受教育程度（OR=1.429，95%CI：1.078-1.896，P=0.013）。