Zhou Xianghai, Ji Linong, Ran Xingwu, Su Benli, Ji Qiuhe, Pan Changyu, Weng Jianping, Ma Changsheng, Hao Chuanming, Zhang Danyi, Hu Dayi
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Peking University Diabetes Center, Beijing, China.
PLoS One. 2016 Jan 4;11(1):e0144179. doi: 10.1371/journal.pone.0144179. eCollection 2016.
There are few data on the prevalence of obesity and its influence on achieving blood glucose, blood pressure, and blood lipid (3B) goals in Chinese type 2 diabetes outpatients.
Patient demographic data, anthropometric measurements, medications, and blood glucose and lipid profiles of 24,512 type 2 diabetes patients from a large, geographically diverse study (CCMR-3B) were analyzed. Using cut-points for body mass index (BMI) and waist circumference (WC) recommended by the Working Group on Obesity in China, overweight and obesity were defined as BMIs of 24-27.9 kg/m2 and ≥28.0 kg/m2. Central obesity was defined as a waist circumference ≥80 cm in women and ≥85 cm in men. The 3B therapeutic goals were HbA1c<7.0%, BP<140/90 mmHg and LDL-C<2.6 mmol/L.
Overall, 43.0% of type 2 diabetes patients were overweight and 16.7% were obese; 13.3% of overweight and and 10.1% of obese patients achieved all the 3B target goals. Overweight or obese patients were less likely to achieve 3B goals than those with normal BMIs. More than a half the overweight or obese patients (69.6%) were centrally obese. Patients with abdominal obesity were less likely to achieve cardiometabolic targets than those without abdominal obesity. In multivariate logistic regression analysis, female, higher BMI and waist circumference, smoking, drinking, sedentary lifestyle, and longer diabetes duration were significantly correlated with failure to achieve 3B control goals.
Obesity is highly prevalent and associated with poor 3B control in Chinese type 2 diabetes patients. In clinical practice, more attention and resources should focus on weight loss for such patients.
关于中国2型糖尿病门诊患者肥胖症患病率及其对实现血糖、血压和血脂(3B)目标的影响的数据较少。
分析了来自一项大型、地域多样的研究(CCMR-3B)的24512例2型糖尿病患者的人口统计学数据、人体测量数据、用药情况以及血糖和血脂谱。根据中国肥胖问题工作组推荐的体重指数(BMI)和腰围(WC)切点,超重和肥胖的定义分别为BMI为24-27.9kg/m²和≥28.0kg/m²。中心性肥胖的定义为女性腰围≥80cm,男性腰围≥85cm。3B治疗目标为糖化血红蛋白(HbA1c)<7.0%、血压<140/90mmHg和低密度脂蛋白胆固醇(LDL-C)<2.6mmol/L。
总体而言,43.0%的2型糖尿病患者超重,16.7%的患者肥胖;13.3%的超重患者和10.1%的肥胖患者实现了所有3B目标。超重或肥胖患者比BMI正常的患者更难实现3B目标。超过一半的超重或肥胖患者(69.6%)存在中心性肥胖。有腹型肥胖的患者比没有腹型肥胖的患者更难实现心脏代谢目标。在多因素逻辑回归分析中,女性、较高的BMI和腰围、吸烟、饮酒、久坐的生活方式以及较长的糖尿病病程与未实现3B控制目标显著相关。
肥胖在中国2型糖尿病患者中非常普遍,并且与3B控制不佳有关。在临床实践中,应更加关注此类患者的体重减轻,并投入更多资源。