普陀区社区管理2型糖尿病管理和控制现况调查

发布时间：2018-01-09 01:00

本文关键词：普陀区社区管理2型糖尿病管理和控制现况调查　出处：《复旦大学》2013年硕士论文　论文类型：学位论文

【摘要】：我国糖尿病患者增长迅速,糖尿病患者的管理已经成为一个重要公共卫生问题和社会问题。糖尿病是一种慢性终身性疾病,血糖控制对预防糖尿病并发症的发生具有重要作用。社区管理和自我管理对患者的血糖控制具有重要影响,掌握糖尿病患者的血糖控制情况、并发症情况,探讨可能的影响因素,可为社区糖尿病患者管理模式和防治策略提供科学依据。目的通过对上海市普陀区社区2型糖尿病管理人群为基础的横断面研究,描述2型患者的综合管理(社区管理和自我管理)现状,掌握糖尿病患者的病情进展情况(血糖水平、血脂水平和慢性并发症),分析社会人口学、病程和综合管理等因素对2型糖尿病控制的影响。方法采用系统抽样方法,对普陀区10个社区在册管理的735例2型糖尿病患者进行横断面调查,评估患者社区管理和自我管理现况,了解血糖、血脂的控制情况和并发症发生情况,运用多因素Logistic回归分析方法对影响2型糖尿病控制的相关因素进行探讨。结果 1.社区管理2型糖尿病患者管理现况普陀区社区管理2型糖尿病患者以老年人为主,60岁以上老年人占患者总数的78.5%；患者病程中位数为10年；70.7%的患者表现有临床症状,44.4%的患者合并慢性并发症；大部分患者采用口服降糖药治疗,采用胰岛素治疗者为21.3%,但随着病程延长,患者胰岛素治疗的比例逐渐提高(Χ2=49.168,P0.001)。16.1%的患者每周进行血糖监测,13.5%的患者每年开展4次以上的糖化血红蛋白(HbAlc)检测；患者的饮食控制率为69.4%,规律运动的比例为58.1%。管理患者对于糖尿病相关症状和并发症的知晓率分别为90.7%和78.6%,但对HbA1c的知晓率仅为24.6%；患者遵医嘱的比例为92.9%；有49.5%的患者接受规范的随访管理,91.2%的患者在随访中同时接受过健康教育。 2.社区管理2型糖尿病患者的血糖、血压和血脂控制情况普陀区社区管理2型糖尿病患者空腹血糖(FPG)平均值为7.66±2.50mmol/L,HbA1C均值为7.60±1.53%。根据上海市糖尿病防治指南(简称“指南”)控制标准,FPG控制理想(4.1-6.1mmol/L)的比例为28.8%,控制不良(7.0mmol/L)的比例为49.1%；以HbAlC6.5%为控制理想的标准,调查对象控制理想的比例为23.7%,控制不良(7.5%)的比例为40.8%；血压控制理想(130/80mmHg)的比例为18.0%,控制不良(≥140/90mmHg)的比例则高达47.8%；总胆固醇控制理想的比例为34.0%,甘油三脂为57.1%,高密度脂蛋白和低密度脂蛋白分别为42.3%和25.0%；体重指数(BMI)控制理想的比例为40.5%；腰臀比(WHR)控制理想的比例为37.3%。 3.社区管理2型糖尿病患者血糖控制的影响因素根据指南推荐,将糖化血红蛋白作为糖尿病患者血糖控制的评估标准,HbAlc6.5%为控制理想,6.5%-7,5%为控制良好,7.5%为控制不良；采用K-W检验分析发现,病程(Χ2=27.976,P0.001)和胰岛素使用(Χ2=10.953,P=0.004)是影响患者血糖控制的重要因素。将HbAlc-≤7.5%的患者定义为血糖控制良好组,HbAlc7.5%的患者定义为血糖控制不良组,在调整性别、年龄、病程和药物使用等混杂因素后,采用Logistic多因素分析法分析血糖控制水平与自我管理和社区管理的联系,影响血糖控制的主要因素包括：患者BMI控制水平(aOR=1.437,95%CI：1.002-2.060)和WHR控制水平(aOR=1.417,95%CI：1.031-1.948),患者的随访时间(aOR=1.016,95%CI：1.007-1.025)、随访次数(aOR=1.046,95%CI：1.030-1.062)和随访的规范性(aOR=0.107,95%CI：10.074-0.153)等。 4.社区管理2型糖尿病患者慢性并发症发生情况 44.4%的患者合并一个或多个并发症；合并心血管系统、脑血管系统、肾脏病变、眼部病变、足部病变和周围神经病变的患病率分别为28.2%、11.3%、3.9%、17.6%、0.7%和2.0%；女性并发症的患病率高于男性(Χ2=4.594,P=0.032)；并发症的患病率随年龄的增长明显增高(Χ2=33.414,P0.001)；随着病程的延长,并发症的患病率也迅速增长(Χ2=23.213,P0.001)。结论普陀区社区管理2型糖尿病患者以老年人为主,病程较长,患者大多采用口服降糖药物治疗；血糖、血压和血脂控制不够理想；并发症患病率较高；患者饮食控制和规律运动执行率不高,社区管理规范性有待提高；影响患者血糖控制的主要因素包括：病程、胰岛素、体质指数、腰臀比和社区随访的规范性。
[Abstract]:Diabetic patients in China is growing rapidly, the management of patients with diabetes mellitus has become an important public health and social problems. Diabetes is a chronic lifelong disease, blood glucose control plays an important role on the prevention of diabetic complications. The community management and self management has an important effect on glycaemic control, grasp the control of blood glucose in diabetic patients the situation, complications, to explore the possible influencing factors, which can provide scientific basis for diabetic patients in community management mode and control strategies.
objective
A cross-sectional study of the city of Shanghai, Putuo District community management of type 2 diabetes population based, description of the comprehensive management of type 2 patients (community management and self management) situation, grasp the progression of diabetic patients (blood glucose levels, blood lipid levels and chronic complications), social demographic analysis, influence of the course and comprehensive management and other factors on the 2 type 2 diabetes control.
Method
Using systematic sampling method, a cross-sectional survey was conducted in 10 communities in Putuo District on the management of 735 cases of patients with type 2 diabetes in community management, patient evaluation and self management to understand the occurrence of blood glucose, blood lipid control and complications were discussed by multivariate Logistic regression analysis on the influence of control of type 2 diabetes related factors.
1. management of type 2 diabetic patients in community management
Putuo District community management of patients with type 2 diabetes in the elderly, the elderly aged 60 and above accounted for 78.5% of the total number of patients; patients with a median of 10 years; 70.7% of the patients showed clinical symptoms, 44.4% patients with chronic complications; most of the patients with oral hypoglycemic drug treatment, the insulin treatment was 21.3%, but with the course prolonged insulin treated patients gradually increase the proportion of (x 2=49.168, P0.001).16.1% patients with weekly blood glucose monitoring, 13.5% patients each year to carry out more than 4 times the glycosylated hemoglobin (HbAlc) detection; the patient's diet control rate was 69.4%, the proportion of regular exercise for the 58.1%. management for patients with diabetes related symptoms and complications of awareness rates were 90.7% and 78.6%, but the awareness rate of HbA1c was 24.6%; the proportion of patients prescribed was 92.9%; 49.5% of the patients received follow-up management standard, 91.2% of the patients received health education at the same time of follow-up.
2. control of blood sugar, blood pressure, and blood lipid in patients with type 2 diabetes mellitus
Putuo District community management of patients with type 2 diabetes fasting blood glucose (FPG) with an average of 7.66 + 2.50mmol/L, the mean HbA1C was 7.60 + 1.53%. according to the Shanghai Diabetes Prevention Guide (hereinafter referred to as the "guidelines") control standard, FPG control ideal (4.1-6.1mmol/L) ratio of 28.8%, poor control (7.0mmol/L) ratio of 49.1% to HbAlC6.5%; the ideal control standard, the survey control ideal proportion is 23.7%, the control side (7.5%) at the rate of 40.8%; the ideal blood pressure control (130/80mmHg) for 18% of the proportion of poor control (more than 140/90mmHg) the proportion is as high as 47.8%; total cholesterol control ideal proportion is 34%, glycerin three fat was 57.1%, high density and low density lipoproteins were 42.3% and 25%; body mass index (BMI) to control the ideal ratio of 40.5%; waist to hip ratio (WHR) control the ideal ratio of 37.3%.
3. influencing factors of blood glucose control in patients with type 2 diabetes mellitus
According to the guidelines, the glycosylated hemoglobin as a blood glucose control in patients with diabetes assessment criteria, HbAlc6.5% for the control of ideal, 6.5%-7,5% is well controlled, 7.5% for poor control; using K-W test analysis showed that the duration (x 2=27.976, P0.001) and insulin (x 2= 10.953, P=0.004) is an important factor affecting the blood glucose control.
The definition of HbAlc- is less than or equal to 7.5% for patients with good glycemic control group, patients with poor glycemic control was defined as the HbAlc7.5% age group, after adjustment for gender, duration, and the use of drugs and other confounding factors, using multivariate Logistic analysis method to analyze the control of blood glucose level and self management and community management, including the main influencing factors of blood glucose control the control level in patients with BMI (aOR=1.437,95%CI:1.002-2.060) and WHR (aOR=1.417,95%CI:1.031-1.948) level of control, follow-up time of patients (aOR=1.016,95%CI:1.007-1.025), follow-up times (aOR=1.046,95%CI:1.030-1.062) standard and follow-up (aOR=0.107,95%CI:10.074-0.153).
4. chronic complications in patients with type 2 diabetes in community management
44.4% patients had one or more complications; combined with cardiovascular system, cerebrovascular system, kidney disease, eye disease, the prevalence rate of foot disease and peripheral neuropathy were 28.2%, 11.3%, 3.9%, 17.6%, 0.7% and 2%; the prevalence rate is higher than the male female complications (x 2=4.594, P=0.032); complications the prevalence rate increased with age (x 2=33.414, P0.001); with the extension of the course, the prevalence rate of complications is also growing rapidly (x 2=23.213, P0.001) conclusion.
Putuo District community management of patients with type 2 diabetes in the elderly, longer course, most of the patients with oral hypoglycemic drug treatment; blood glucose, blood lipid and blood pressure control is not ideal; the incidence of complications is higher in patients with diet control and regular exercise; the execution rate is not high, the community management standard needs to be improved; including the main factors influencing the patients' blood glucose control course, insulin, body mass index, waist hip ratio and normative community follow-up.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R587.1

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