Pati Sandipana, Schellevis F G
Department of Health & Family Welfare, Government of Odisha, Bhubaneswar, Odisha, India.
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands, and Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute,VU University Medical Center, Amsterdam, the Netherlands.
PLoS One. 2017 Aug 25;12(8):e0181661. doi: 10.1371/journal.pone.0181661. eCollection 2017.
India has the second largest diabetic population in the world. The chronic nature of the disease and high prevalence of co-existing chronic medical conditions or "co morbidities" makes diabetes management complex for the patient and for health care providers. Hence a strong need was felt to explore the problem of co morbidity among diabetics and its dimensions in primary health care practices.
This cross sectional survey was carried out on 912 type 2 diabetes patients attending different urban primary health care facilities at Bhubaneswar. Data regarding existence of co morbidity and demographical details were elicited by a predesigned, pretested questionnaire"Diabetes Co morbidity Evaluation Tool in Primary Care (DCET- PC)". Statistical analyses were done using STATA.
Overall 84% had one ormore than one comorbid condition. The most frequent co morbid conditions were hypertension [62%], acid peptic disease [28%], chronic back ache [22%] and osteoarthritis [21%]. The median number of co morbid conditions among both males and females is 2[IQR = 2]. The range of the number of co morbid conditions was wider among males [0-14] than females [0-6]. The number of co morbidities was highest in the age group > = 60 across both sexes. Most of the male patients below 40 years of age had either single [53%] or three co morbidities [11%] whereas among female patients of the same age group single [40%] or two co morbidities [22%] were more predominantly present. Age was found to be a strong independent predictor for diabetes co morbidity. The odds of having co morbidity among people above poverty line and schedule caste were found to be[OR = 3.50; 95%CI 1.85-6.62]and [OR = 2.46; CI 95%1.16-5.25] respectively. Odds were increased for retired status [OR = 1.21; 95% CI 1.01-3.91] and obesity [OR = 3.96; 95%CI 1.01-15.76].
The results show a high prevalence of co morbidities in patients with type 2 diabetes attending urban primary health care facilities. Hypertension, acid peptic disease, chronic back ache and arthritis being the most common, strategies need to be designed taking into account the multiple demands of co morbidities.
印度是世界上糖尿病患者数量第二多的国家。该疾病的慢性性质以及并存慢性疾病或“合并症”的高患病率，使得糖尿病管理对于患者和医疗服务提供者而言都很复杂。因此，人们强烈感到有必要探讨糖尿病患者中的合并症问题及其在初级卫生保健实践中的情况。
对在布巴内斯瓦尔不同城市初级卫生保健机构就诊的912名2型糖尿病患者进行了这项横断面调查。通过预先设计、预先测试的问卷“初级保健糖尿病合并症评估工具（DCET-PC）”获取有关合并症存在情况和人口统计学细节的数据。使用STATA进行统计分析。
总体而言，84%的患者有一种或多种合并症。最常见的合并症是高血压[62%]、酸相关性胃病[28%]、慢性背痛[22%]和骨关节炎[21%]。男性和女性合并症的中位数均为2[四分位间距=2]。男性合并症数量的范围[0-14]比女性[0-6]更宽。60岁及以上年龄组的合并症数量在两性中都是最高的。大多数40岁以下的男性患者有单一合并症[53%]或三种合并症[11%]，而在同一年龄组的女性患者中，单一合并症[40%]或两种合并症[22%]更为常见。年龄被发现是糖尿病合并症的一个强有力的独立预测因素。发现贫困线以上人群和在册种姓人群患合并症的几率分别为[比值比=3.50；95%置信区间1.85-6.62]和[比值比=2.46；95%置信区间1.16-5.25]。退休状态[比值比=1.21；95%置信区间1.01-3.91]和肥胖[比值比=3.96；95%置信区间1.01-15.76]的几率增加。
结果显示，在城市初级卫生保健机构就诊的2型糖尿病患者中合并症的患病率很高。高血压、酸相关性胃病、慢性背痛和关节炎最为常见，需要考虑到合并症的多种需求来制定策略。
