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  本文關鍵詞：普陀區(qū)社區(qū)管理2型糖尿病管理和控制現(xiàn)況調(diào)查　出處：《復旦大學》2013年碩士論文　論文類型：學位論文

  更多相關文章： 2型糖尿病 社區(qū)管理 血糖控制 并發(fā)癥 影響因素

【摘要】：我國糖尿病患者增長迅速,糖尿病患者的管理已經(jīng)成為一個重要公共衛(wèi)生問題和社會問題。糖尿病是一種慢性終身性疾病,血糖控制對預防糖尿病并發(fā)癥的發(fā)生具有重要作用。社區(qū)管理和自我管理對患者的血糖控制具有重要影響,掌握糖尿病患者的血糖控制情況、并發(fā)癥情況,探討可能的影響因素,可為社區(qū)糖尿病患者管理模式和防治策略提供科學依據(jù)。 目的 通過對上海市普陀區(qū)社區(qū)2型糖尿病管理人群為基礎的橫斷面研究,描述2型患者的綜合管理(社區(qū)管理和自我管理)現(xiàn)狀,掌握糖尿病患者的病情進展情況(血糖水平、血脂水平和慢性并發(fā)癥),分析社會人口學、病程和綜合管理等因素對2型糖尿病控制的影響。 方法 采用系統(tǒng)抽樣方法,對普陀區(qū)10個社區(qū)在冊管理的735例2型糖尿病患者進行橫斷面調(diào)查,評估患者社區(qū)管理和自我管理現(xiàn)況,了解血糖、血脂的控制情況和并發(fā)癥發(fā)生情況,運用多因素Logistic回歸分析方法對影響2型糖尿病控制的相關因素進行探討。結(jié)果 1.社區(qū)管理2型糖尿病患者管理現(xiàn)況 普陀區(qū)社區(qū)管理2型糖尿病患者以老年人為主,60歲以上老年人占患者總數(shù)的78.5%；患者病程中位數(shù)為10年；70.7%的患者表現(xiàn)有臨床癥狀,44.4%的患者合并慢性并發(fā)癥；大部分患者采用口服降糖藥治療,采用胰島素治療者為21.3%,但隨著病程延長,患者胰島素治療的比例逐漸提高(Χ2=49.168,P0.001)。16.1%的患者每周進行血糖監(jiān)測,13.5%的患者每年開展4次以上的糖化血紅蛋白(HbAlc)檢測；患者的飲食控制率為69.4%,規(guī)律運動的比例為58.1%。管理患者對于糖尿病相關癥狀和并發(fā)癥的知曉率分別為90.7%和78.6%,但對HbA1c的知曉率僅為24.6%；患者遵醫(yī)囑的比例為92.9%；有49.5%的患者接受規(guī)范的隨訪管理,91.2%的患者在隨訪中同時接受過健康教育。 2.社區(qū)管理2型糖尿病患者的血糖、血壓和血脂控制情況 普陀區(qū)社區(qū)管理2型糖尿病患者空腹血糖(FPG)平均值為7.66±2.50mmol/L,HbA1C均值為7.60±1.53%。根據(jù)上海市糖尿病防治指南(簡稱“指南”)控制標準,FPG控制理想(4.1-6.1mmol/L)的比例為28.8%,控制不良(7.0mmol/L)的比例為49.1%；以HbAlC6.5%為控制理想的標準,調(diào)查對象控制理想的比例為23.7%,控制不良(7.5%)的比例為40.8%；血壓控制理想(130/80mmHg)的比例為18.0%,控制不良(≥140/90mmHg)的比例則高達47.8%；總膽固醇控制理想的比例為34.0%,甘油三脂為57.1%,高密度脂蛋白和低密度脂蛋白分別為42.3%和25.0%；體重指數(shù)(BMI)控制理想的比例為40.5%；腰臀比(WHR)控制理想的比例為37.3%。 3.社區(qū)管理2型糖尿病患者血糖控制的影響因素 根據(jù)指南推薦,將糖化血紅蛋白作為糖尿病患者血糖控制的評估標準,HbAlc6.5%為控制理想,6.5%-7,5%為控制良好,7.5%為控制不良；采用K-W檢驗分析發(fā)現(xiàn),病程(Χ2=27.976,P0.001)和胰島素使用(Χ2=10.953,P=0.004)是影響患者血糖控制的重要因素。 將HbAlc-≤7.5%的患者定義為血糖控制良好組,HbAlc7.5%的患者定義為血糖控制不良組,在調(diào)整性別、年齡、病程和藥物使用等混雜因素后,采用Logistic多因素分析法分析血糖控制水平與自我管理和社區(qū)管理的聯(lián)系,影響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),患者的隨訪時間(aOR=1.016,95%CI：1.007-1.025)、隨訪次數(shù)(aOR=1.046,95%CI：1.030-1.062)和隨訪的規(guī)范性(aOR=0.107,95%CI：10.074-0.153)等。 4.社區(qū)管理2型糖尿病患者慢性并發(fā)癥發(fā)生情況 44.4%的患者合并一個或多個并發(fā)癥；合并心血管系統(tǒng)、腦血管系統(tǒng)、腎臟病變、眼部病變、足部病變和周圍神經(jīng)病變的患病率分別為28.2%、11.3%、3.9%、17.6%、0.7%和2.0%；女性并發(fā)癥的患病率高于男性(Χ2=4.594,P=0.032)；并發(fā)癥的患病率隨年齡的增長明顯增高(Χ2=33.414,P0.001)；隨著病程的延長,并發(fā)癥的患病率也迅速增長(Χ2=23.213,P0.001)。結(jié)論 普陀區(qū)社區(qū)管理2型糖尿病患者以老年人為主,病程較長,患者大多采用口服降糖藥物治療；血糖、血壓和血脂控制不夠理想；并發(fā)癥患病率較高；患者飲食控制和規(guī)律運動執(zhí)行率不高,社區(qū)管理規(guī)范性有待提高；影響患者血糖控制的主要因素包括：病程、胰島素、體質(zhì)指數(shù)、腰臀比和社區(qū)隨訪的規(guī)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.

【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R587.1

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