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沙特阿拉伯塔布克慢性病诊所中2型糖尿病患者的糖尿病并发症及影响血糖控制的因素

Diabetic Complications and Factors Affecting Glycemic Control Among Patients With Type II Diabetes Mellitus Attending the Chronic Illness Clinics at Tabuk, Saudi Arabia.

作者信息

Ghabban Shahad J, Althobaiti Bashayr, Farouk Ibrahim M, Al Hablany Manea, Ghabban Ahmad, Alghbban Rawabi, Harbi Saleh, Albalawi Asem E

机构信息

Department of Family Medicine, King Salman Northwest Armed Forces Hospital, Tabuk, SAU.

College of Medicine, University of Tabuk, Tabuk, SAU.

出版信息

Cureus. 2020 Nov 24;12(11):e11683. doi: 10.7759/cureus.11683.

Abstract

Background Diabetes mellitus (DM) is one of the most common diseases worldwide and affects many patients all over the globe. Diabetic complications vary between microvascular and macrovascular, affecting a wide range of organs and systems in the body. Understanding, determining, and in return, preventing such factors is essential to alleviate the quality of life of diabetic patients. Therefore, we aim to determine the poor glycemic control and the factors associated with it in our diabetes population. Methods This is a retrospective study where data was reviewed for all patients with Type II DM (T2DM) who attended the chronic illness clinic at King Khaled Hospital in Tabuk. We included patients aged ≥ 18 years, of Saudi nationality, and residents of the Tabuk region. Any patient not satisfying all the inclusion criteria was excluded from the current study. Diagnosis with diabetes was made according to the American Diabetes Association guidelines, 2020. Patients' demographic data, medical history, and social and lifestyle history were extracted from records. In addition, age, body mass index (BMI), drugs (insulin vs. oral hypoglycemic agents), duration of the disease, lipid profile, and other comorbidities were also extracted from the files. A p-value of <0.05 was selected as the statistically significant level in all tests. Results A total of 697 patients were included in the current study, with a mean age of 58.2±11.6 years. The mean glycosylated hemoglobin (HbA1c) of the study participants was 8.4±1.7%, and their fasting blood sugar (FBS) level was 9.9±3.9 mmol/l. With HbA1c cut-off at 7%, the overall prevalence of poor glycemic control was 81.5% (565/693). A higher prevalence of poor glycemic control was reported among study participants with higher DM duration (p=0.002). Diabetes complications were found in 208 (29.8%) of the study participants, where microvascular complications were present in 140 patients, and microvascular ones were found in 102. In the logistic regression model, older patients were less prone to poor glycemic control (OR=0.98; 95% CI=0.96-0.99; p=0.010). In addition, longer disease duration was a predictive factor of poor glycemic control (OR=1.05; 95% CI=1.02-1.08; p=0.003). Furthermore, the usage of combined insulin and tablet treatments were associated with a higher risk of poor glycemic control when compared to insulin only treatments (OR=4.65; 95% CI=1.55-13.94; p=0.006). Conclusion The results of this study indicate a high prevalence rate of poor glycemic control among Saudi patients, which is higher than previous reports have shown. More interest should be given to awareness programs with regard to promoting self-control protocols for the disease.

摘要

背景 糖尿病(DM)是全球最常见的疾病之一,影响着全球众多患者。糖尿病并发症分为微血管并发症和大血管并发症,会影响身体的多个器官和系统。了解、确定并进而预防这些因素对于改善糖尿病患者的生活质量至关重要。因此,我们旨在确定我们糖尿病患者群体中血糖控制不佳的情况及其相关因素。

方法 这是一项回顾性研究,对所有在塔布克的哈立德国王医院慢性病门诊就诊的II型糖尿病(T2DM)患者的数据进行了审查。我们纳入了年龄≥18岁、沙特国籍且居住在塔布克地区的患者。任何不符合所有纳入标准的患者均被排除在本研究之外。根据2020年美国糖尿病协会指南进行糖尿病诊断。从记录中提取患者的人口统计学数据、病史以及社会和生活方式史。此外,还从档案中提取了年龄、体重指数(BMI)、药物(胰岛素与口服降糖药)、病程、血脂谱以及其他合并症。在所有测试中,选择p值<0.05作为具有统计学意义的水平。

结果 本研究共纳入697例患者,平均年龄为58.2±11.6岁。研究参与者的平均糖化血红蛋白(HbA1c)为8.4±1.7%,空腹血糖(FBS)水平为9.9±3.9 mmol/l。以HbA1c截止值7%计算,血糖控制不佳的总体患病率为81.5%(565/693)。病程较长的研究参与者中血糖控制不佳的患病率较高(p=0.002)。208例(29.8%)研究参与者出现糖尿病并发症,其中140例存在微血管并发症,102例存在大血管并发症。在逻辑回归模型中,老年患者血糖控制不佳的倾向较小(OR=0.98;95%CI=0.96-0.99;p=0.010)。此外,病程较长是血糖控制不佳的预测因素(OR=1.05;95%CI=1.02-1.08;p=0.003)。此外,与仅使用胰岛素治疗相比,联合使用胰岛素和片剂治疗与血糖控制不佳的风险较高相关(OR=4.65;95%CI=1.55-13.94;p=0.006)。

结论 本研究结果表明沙特患者中血糖控制不佳的患病率较高,高于以往报告显示的水平。应更加关注提高疾病自我控制方案的宣传项目。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c6b7/7769739/6c0099b8689a/cureus-0012-00000011683-i01.jpg

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