胰岛素泵治疗糖尿病患者血糖控制及影响因素分析  

Analysis of influence factor for glycemic control in diabetic patients with insulin pump treatment

作　　者：梁雪[1] 陈康[1] 王安平[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《中国医药导报》2016年第15期72-76,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(81471026)

摘　　要：目的了解长期胰岛素泵治疗的糖尿病患者血糖控制情况,分析相关影响因素,为糖尿病个体化治疗提供参考。方法 2014年2~4月美敦力公司对其中国大陆地区长期使用胰岛素泵的用户进行电话回访并建立数据库,从中抽取有最近一次糖化血红蛋白（Hb A1c）值,且未停止胰岛素泵使用的用户记录835例。纳入信息主要包括：用户一般资料、自我管理信息、主观感受及实验室检查数据。按最近一次Hb A1c分为两组：血糖控制组（Hb A1c〈7.0%）和血糖控制不良组（Hb A1c≥7.0%）,采用SPSS 23.0及Excel软件对样本人群进行统计分析。结果 1纳入人群戴泵前3~6个月内及最近一次Hb A1c平均值分别为（8.5±2.2）%、（7.1±1.4）%,糖化控制率依次为17.5%、42.0%,差异均有统计学意义（P〈0.05）。2血糖控制组与血糖控制不良组的戴泵前餐后血糖（PBG）、戴泵前Hb A1c、最近一次空腹血糖（FBG）、最近一次PBG、最近一次Hb A1c和总体满意度,差异有高度统计学意义（P〈0.01）;起始用泵年龄、当前年龄,差异有统计学意义（P〈0.05）。3不同血糖控制组的患者所在地区、熟练用泵度、主观感受中的血糖控制情况及饮食情况构成比,差异有统计学意义（P〈0.05）。4以最近一次Hb A1c达标情况为因变量,建立Logistic回归模型,结果显示：起始用泵年龄（P=0.000）、戴泵前FBG（P=0.031）、最近一次FBG（P=0.000）、所在区域（P=0.001）、主观感受中的血糖控制情况（P=0.000）和并发症情况（P=0.013）均为血糖控制的影响因子。结论长期胰岛素泵治疗的糖尿病患者血糖控制率较用泵前显著上升,均衡发展各地医疗水平,加强血糖监测、疾病重视程度及患者主观信心方面的教育将更有利于血糖控制率提升。Objective To evaluate glycemic control in diabetic patients with long-term insulin pump therapy, analyze influence factors, and provide reference for individual management of diabetes mellitus. Methods 835 long-term insulin pump users selected from the database of Medtronic＇s telephone interview project conducted in Chinese mainland from February to April 2014 were analyzed with respect to demographics, self-management, subjective feeling and laboratory data. Inclusion criteria was that patients didn＇t stop pump therapy and had the latest glycosylated hemoglobin（Hb A1c） value. According to the last time Hb A1 clevel, patients were divided into the blood glucose well-controlled group（Hb A1c7.0%） and blood glucose poorly-controlled group（Hb A1c≥7.0%）. SPSS 23.0 and Excel software were used for data processing. Results 1The mean Hb A1c3-6 months before pump usage was（8.5±2.2）%, obviously higher than that in the latest follow-up（7.1 ±1.4） %（P 0.05）. The control rate of blood glucose before pump usage was17.5%, obviously lower than that in the latest follow-up 42.0%（P 0.05）. 2Between blood glucose well-controlled group and poorly-controlled group, differences regarding postprandial plasma glucose（PBG） and Hb A1 cbefore using insulin pump, fasting plsama glucose（FBG）, PBG and Hb A1 cafter pump usage and overall satisfaction were highly significant（P 0.01）, and differences regarding initial age of pump therapy and current age were also significant（P 0.05）. 3The constituent proportions of region, pump usage proficiency and subject feelings such as better controlling blood glucose and free diet were significant differences in both control level groups（P 0.05）. 4Taken Hb A1 cstandard of last time as dependent variable, Logistic regression analysis showed that the initial age of pump usage（P =0.000）,FBG before pump therapy（P=0.031）, the latest FBG（P=0.000）, region（P=0.001）, subjective feelings such as control quality（P=0.000） and complications（P=0

关 键 词：胰岛素泵 糖尿病 血糖控制 影响因素 

分 类 号：R587.1[医药卫生—内分泌]