上海市社区管理2型糖尿病患者血糖控制和用药情况  

Glycemic Control and Medication Compliance of Type 2 Diabetes in Community Management System in Shanghai

作　　者：李锐[1] 施亮[1] 杨群娣[1] 吴照帆 阮晔[1] 黎衍云[1] 齐健[1] 

机构地区：[1]上海市疾病预防控制中心慢性病与伤害防治所,上海200336 [2]复旦大学公共卫生学院流行病学教研室,上海200032

出　　处：《环境与职业医学》2016年第4期329-333,共5页Journal of Environmental and Occupational Medicine

基　　金：上海市公共卫生重点学科建设计划(编号:12GWZX0101)

摘　　要：[目的]了解上海市社区管理2型糖尿病患者治疗和血糖控制状况及其变化趋势。[方法]于2009和2013年,分别从上海市社区糖尿病患者管理系统中随机抽样1 710名和2 800名2型糖尿病患者,对其进行问卷调查、体格检查和实验室检查,收集患者人口学信息、治疗方案、血糖控制情况。[结果]两次调查分别回收有效问卷1 629、2 741份。2009年到2013年间,社区管理2型糖尿病患者血糖控制达标率由43.7%上升到46.8%;用药依从率由88.1%提升到94.8%。2013年使用最广泛的口服降糖药依次为磺脲类(53.3%)、双胍类药物(40.1%)和糖苷酶抑制剂类(15.8%),磺脲类药物使用率较2009年(59.4%)显著下降(P<0.05),双胍类药物和糖苷酶抑制剂类无明显变化,胰岛素的使用比例也无变化。仅口服降糖药的患者血糖达标率高于使用胰岛素的患者,单纯一种药物治疗的患者达标率优于联合多种药物治疗的患者(P<0.05)。[结论]社区管理可明显提高2型糖尿病患者药物依从性和血糖控制达标率,但社区医生对降糖药物的使用与国内、外防治指南还存有差距,应及时制定政策加强对社区糖尿病防治的技术支持。[Objective] To assess the status and trends of treatment of type 2 diabetes mellitus（T2DM） and glycemic control in Shanghai communities. [Methods] In 2009 and 2013, 1 710 and 2 800 patients with T2 DM were randomly selected from the Shanghai community diabetes management system respectively. Data on demographic information, treatment regimen, blood glucose levels were collected by questionnaire interviews, physical examinations, and laboratory tests. [Results] A total of 1 629 and 2 741 valid questionnaires were returned. The control rate（prevalence rate of patients meeting the control target of Hb A1c〈7%） rose from 43.7% in 2009 to 46.8% in 2013, and the rate of treatment compliance increased from 88.1% to 94.8%. Sulfonylureas（53.3%）, despite of a significant decrease in its use（P〈0.05）, remained to be the mainstay of oral anti-diabetic treatment, followed by metformin（40.1%） and α-glycosidase inhibitors（15.8%）, and the use of metformin, α-glycosidase inhibitors, and insulin had no changes. Patients receiving insulin or combination therapy had worse glucose control rates than those having oral hypoglycemic agents alone or single medicine therapy. [Conclusion] Community administration can significantly improve the treatment compliance and glucose control of patients with T2 DM. However, community health professionals are comparatively unfamiliar with the scientific usage of hypoglycemic drugs as well as national and international diabetes treatment principles. Thus, timely preparing policies is needed to strengthen technical support in diabetes control for community hospitals.

关 键 词：2型糖尿病 血糖控制 口服降糖药 胰岛素 

分 类 号：R181.3[医药卫生—流行病学] R587.1[医药卫生—公共卫生与预防医学]