上海不同级别医院糖尿病控制、生活习惯及自我管理状况  

Diabetes control,patient habit and self-management in hospitals of different levels:a pilot study in Shanghai

作　　者：周莹霞[1] 程军 赵列宾[1] 盛宏光[3] 陈玲[4] 张兴元 施荣康 沈世豪 孟鸿建 陈钦达[1] 陆骆[1] 苏莉珍[1] 王琴琴[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院糖尿病中心,上海市内分泌代谢病临床医学中心,200025 [2]解放军四五五医院 [3]上海市徐汇区中心医院 [4]上海交通大学医院附属瑞金医院卢湾分院 [5]上海市天山中医院 [6]上海市周家桥社区卫生服务中心 [7]上海市仙霞社区卫生服务中心 [8]上海市程家桥社区卫生服务中心

出　　处：《上海医学》2009年第7期602-606,共5页Shanghai Medical Journal

基　　金：上海申康医院发展中心课题(SHDC12007318)

摘　　要：目的比较上海不同级别医院糖尿病患者血糖控制、生活习惯和自我管理等方面的差异。方法2005年8月16日—9月23日在上海市7所医院门诊就诊的糖尿病患者中随机入选792例,分别为1所三级医院(249例)、2所二级医院(168例)和4所一级医院(375例),在门诊开展直接询问法调查。结果社区医院糖尿病患者初中以下文化程度占63.2%,显著高于二、三级医院(分别为38.1%、35.7%,P值均<0.01)。三级医院有糖尿病慢性并发症的构成比显著高于一、二级医院(P值均<0.01)。一级医院的空腹血糖(FBG)达标率为25.3%,显著低于二、三级医院(分别为48.8%、49.8%,P值均<0.01);餐后2h血糖(2hPG)达标率为38.9%,显著低于二级医院的54.8%(P<0.01)和三级医院的47.4%(P<0.05)。每日蔬菜摄入量超过400g的糖尿病患者仅占32.1%,一级医院(5.2%)显著低于二级医院(31.5%)和三级医院(57.8%,P值均<0.01)。最近1个月内,71.8%(569例)的患者未在家中监测过血糖,一级医院的餐前、餐后血糖监测比率分别为78.9%、42.4%,均显著低于三级医院(分别为88.4%、68.7%,P值均<0.01);一级医院的糖尿病患者每天检查双足的比例为88.8%,低于三级医院的96.0%(P<0.05);一级医院的低血糖发生率为14.1%,显著低于二、三级医院(分别为28.6%、20.9%,P值均<0.01)。结论被调查的上海市不同级别医院糖尿病患者在文化程度、并发症、低血糖发生等方面存在差异。一级医院糖尿病患者的血糖控制达标率较低,而三级和二级医院在糖尿病管理方面也存在不足。不同级别医院就诊的糖尿病患者在饮食、运动、蔬菜摄入量、血糖监测、足部护理等方面存在不同特点。因此,应根据不同类型医疗机构糖尿病患者的实际情况,开展有针对性的分类指导。Objective To study the differences of diabetes control, patient habit and self-management in seven hospitals in Shanghai. Methods Totally 792 diabetic patients from the outpatient department of one Grade 3 hospitals （249）, 2 Grade 2 hospitals, and 4 Grade 1 hospitals （Aug. 16, 2005 to Sept. 23, 2005） were enrolled in the present study and were surveyed by a questionnaire. Results We found that 63.3% patients in the Grade 1 hospital had a education background lower than junior high school, significantly higher than those in Grade 2, and 3 hospitals （P^0.01）. The Grade 3 hospital had significantly more patients with chronic complications compared with the other grades of hospitals （P〈0.01）. Fasting blood glucose （FBG） of patients in Grade 3 was 8.40 mmol/L, significantly higher than those in the other two grades of hospitals （P^0.01）. The control rate of diabetes was significantly lower in the Grade 3 hospital （25.4 % ） compared with those in the other two hospitals （49.0% and 49.6% ）. The control rate of 2hPG in Grade 3 hospital was 39%, significantly lower than those of the other two grades of hospitals （54.5% and 47.5%, P〈0.01 or 0.05）. Only 32.1% （254） patients ate more than 400 g green vegetable everyday; the number was 15.3% （57 cases） in the Grade 3 hospitals, which was significantly less than other two grades of hospitals （31.5% and 57.9%, P〈0.01 ）. In the latest survey, 71.8% patients did not monitor the blood glucose at home. The rate of pre-meal blood glucose testing was 78.8% （296 cases） in Grade 1 hospitals and 88.4 % （220 cases） in the Grade 3 hospitals（P〈0.01）. The percentage of post- meal blood glucose testing was 42.4% （159 cases） in Grade 1 hospitals and 68.5% （171 cases） in Grade 3 hospitals （P〈0.01）. The patients in Grade 1 hospitals （88.7 %, 333 cases） who examined their foots everyday were less than in the other two grades of hospitals （P^0.05）. In the last month, patients （14.2%, 53 cases） with hypog

关 键 词：糖尿病 医院 控制 自我管理 

分 类 号：R587.1[医药卫生—内分泌]