2型糖尿病患者血糖控制早期个体化治疗策略与达标研究  

The relationship of early individual glycemic control strategy and reaching standard in newly diagnosed type 2 diabetes

作　　者：孙明晓[1] 蒋蕾[1] 于冬妮[1] 汪耀[1] 迟家敏[1] 郭立新[1] 李铭[1] 李慧[1] 鲜彤章[1] 

机构地区：[1]卫生部北京医院内分泌科,100730

出　　处：《中华糖尿病杂志》2013年第12期745-749,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：“十五”国家科技攻关课题（2001BA702801,2004BA702801）;“十一五”国家科技支撑计划课题：2006BAl02808）

摘　　要：目的分析个体化降糖治疗策略对早期诊断2型糖尿病患者血糖控制的影响。方法对2002年6月至2003年5月全国10家三甲医院内分泌科病房中的1396例2型糖尿病患者用药及血糖控制情况进行回顾性分析，均为新诊断或病程在1年之内的患者，年龄（51±9）岁，体质指数（BMI）为（24．9±3．0）kg／m2。。治疗方案根据复杂程度分为未用药（A组）、单种口服药（B组）、口服药联合治疗（c组）及含胰岛素的治疗（D组）四种情况，分析治疗方案调整前、调整后及干预开始后随访20个月间对患者血糖的影响。计数资料与计量资料组间比较分别采用x2检验和协方差分析，干预前后比较使用配对t检验。影响血糖疗效的相关因素分析采用Pearson相关分析。结果（1）治疗方案调整前患者空腹血糖为（7．5±2．4）mmol／L、糖化血红蛋白（HbAlC）为（7．3±1．9）％。经干预后随访第20个月时患者空腹血糖为（6．7±1．6）mmol／L，HbAle为（6．1±1．4）％。（2）对HbAlC〉7％的患者，磺脲类和（或）双胍类单药或联合治疗是本研究中临床医师最常选用的治疗方式，其HbAlC的达标率分别为79．2％、81．9％，二者差异无统计学意义（妒=0．445，P〉0．05）。（3）随访期末的HbAlC水平与患者的年龄（r=0．087，P〈0．01）、起始HbAlC水平（r=0．228，P〈0．001）呈显著正相关关系。与治疗方案的复杂性接近正相关，但是差异没有统计学意义（r=0．054，P〉0．05）。与性别、体重、BMI及高血压病史等均无相关性（r值分别为：0．053、0．011、0．019和-0．034，均P〉0．05）。结论2型糖尿病患者早期以传统口服降糖药为主的个体化治疗可以长期、有效、安全地控制血糖。对起始血糖较高的患者应采取更为积极的胰岛素强化方案。Objective To analyze the early therapy strategy on glucose control in type 2 diabetic patients. Methods From June 2002 to May 2003, the medication and blood glucose control in 1396 cases with type 2 diabetes in national 10 grade 3A hospitals were retrospectively analyzed. The patients were diagnosed newly or within one year in CDCPS （ Chinese Diabetes Complication Prevention Study） , with （51 ＋9）yrs, body mass index （BMI） （24. 9 ＋ 3.0 ）kg/m2. Besides the same instruction of lifestyle intervention, the patients were further divided as four groups ： without intervention （ group A） , single oral hypoglyeemic agent （group B ）, combined oral hypoglycemic agents （group C ） and treatment including insulin（group D）. The X2 test and analysis of covariance was used for count data and measurement data between groups. The paired t test was used comparison before and after the intervention. Pearson correlation analysis was used for factors affecting the efficacy of glucose analysis. Results （ 1 ） The level of HbA1 e at baseline was （7.3 ＋ 1.9 ）%, and the fasting blood-glucose （FBG） was （7.5 ＋ 2. 4）mmol/L among the four intervention group before the treatment adjusted. After 20 months of follow-up, the mean FBG and HbA1 c reached to （6. 7 ＋ 1.6） mmol/L and （6. 1 ＋ 1.4） %, respectively. （2） For patients with HbAlc 〉7%,sulfonylurea and （or） biguanide monotherapy or combination therapy in this study was the most frequently chosen treatment. Compliance rates of HbAlc were 79. 2%, 81.9%, respectively. The difference was not statistically significant. （3） HbA1 c levels at the end of the follow-up and the patient＇s age （r = 0. 087, P 〈 0. 01） , initial HbAlc levels （r =0. 228, P 〈0. 001 ） showed a significant positive correlation. But HbAlc levels showed no correlation with body weight, BMI and hypertension（r = 0. 053, 0. 011,0. 019, - 0. 034, all P 〉 0. 05 ）. Conclusion According to the levels of glucose and HbA1 c, the early indi

关 键 词：糖尿病 2型 血红蛋白A 糖基化 治疗策略 

分 类 号：R587.1[医药卫生—内分泌]