摘要
目的了解我国2型糖尿病（T2DM）治疗及达标现状，重点了解口服降糖药联合胰岛素治疗血糖达标状况。方法由中华医学会糖尿病学分会“糖化血红蛋白监测网”项目组于2009年7至9月在全国范围内选择具有代表性的75个城市的400家医院参加本横断面研究。正在接受口服降糖药联合／不联合胰岛素治疗的年龄≥18岁的2型糖尿病患者均可进入研究。采用问卷形式调查患者一般信息、糖尿病病程、糖尿病并发症及合并症、糖化血红蛋白（HbAlc）、空腹血糖、餐后血糖及治疗药物。所有数据均使用SAS9．13软件进行统计学处理。结果最终共纳入T2DM患者143123例，其中男73544例，女69579例，中位年龄59岁，中位病程6年。在应用口服降糖药联合胰岛素治疗的患者中，最多应用的是预混胰岛素（65．5％，34487／52649），其次是基础胰岛素（24．3％，12794／52649），8．5％（4492／52649）的患者应用基础＋餐时胰岛素。按照HbAlc〈6．5％计算达标率，总体人群达标率为20．2％（28985／143123）。单纯使用口服药治疗的患者HbAlc达标率（23．4％，21163／90474）高于总体人群，使用口服降糖药联合胰岛素的患者HbAlc达标率（14．9％，7822／52649）低于总体人群。不同胰岛素治疗方案组达标率接近[基础胰岛素组15．2％（1944／12794），预混胰岛素组14．9％（5150／34487），基础＋餐时胰岛素组14．6％（656／4492）]。随着糖尿病病程延长，各胰岛素治疗方案组达标率均呈降低趋势（均P〈0．05），早启用胰岛素的患者较晚启用胰岛素的患者达标率更高（均P〈0．01）。T2DM患者血压及血脂达标率分别为：血压23．5％（33676／143123），甘油三酯37．4％（53550／143123），总胆固醇41．4％（59320／143123），高密度脂蛋白胆固醇19．2％（27418／143123），低密度脂蛋白胆固醇41．7％（59671／143123）。结论我国T2DM患者HbAlc总体达标率低，口服药联合胰岛素的患者达标率低于总体达标率。提示大部分患者仍需要得到更加积极有效的个体化治疗。
Objective To assess current treatment and glycaemic control of adult subjects with type 2 diabetes mellitus （T2DM） in China, focusing on the therapy of oral anti-diabetic drugs （OAD） in combination with insulin. Methods From July to September in 2009, 400 hospitals from 75 cities across China were selected by Chinese Diabetes Society for this cross-sectional study. All the T2DM patients （over 18 years） with oral antidiabetic drug （OAD） with/without insulin were eligible for this study. General information of the patients, duration of diabetes, medical history, diabetes complications and concomitant diseases, glyeated hemoglobin Alc （HbAle）, fasting blood glucose （FBG）, postprandial blood glucose （PBG） and treatment regimen were recorded. All data were analyzed by using SAS 9. 13 software. Results A total of 143 123 eligible T2DM patients were enrolled in this study （73 544 males and 69 579 females, median age 59 years, median duration of diabetes 6 years）. Among the patients treated with insulin plus OADs, the most frequently used insulin is pre-mix insulin （65.5% , 34 487/52 649 ） , followed by basal insulin （24. 3%, 12 794/52 649） and basal-bolus insulin （8.5%, 4492/52 649）. The percentage of patients achieved HbAlc 〈6. 5% was 20. 2% （28 985/143 123） for the overall populations, and 23.4% （21 163/90 474） and 14. 9% （7822/52 649） for the patients treated with OADs only and insulin plus OADs respectively. Within patients treated with insulin plus OADs, the percentage of patients achieving HbAlc 〈6.5% were 15.2% （1944/12 794）, 14.9% （5150/34 487） and 14. 6% （656/4492） for basal insulin group, pre-mixed insulin group and basal-bolus insulin group respectively. The percentage of patients achieving HbA1 c target decreased with the increase of duration of diabetes （ all P 〈 0. 05 ）. Patients initiated insulin therapy in the earlier stage had more chance to achieve HbAle target （all P 〈0. 01 ）. Data from this study also indicated that the percentage of patients achieving blood pressure and blood lipid profile target remained low in China. In total, there were 23.5% （ 33 676/143 123 ） of the subjects reached blood pressure target and 37.4% （53 550/143 123）, 41.4% （59 320/143 123）, 19. 2% （27 418/143 123 ） and 41.4% （59 671/143 123） of subjects reached triglyceride（ TG）, total cholesterol（ TC）, high-density lipoprotein cholesterol （ HDL-C ） and low-density lipoprotein cholestorol （ LDL-C ） targets, respectively. Conclusion The overall rate of achieving glycaemic control target remained low in Chinese patients with T2DM, which was even lower for those treated with insulin plus OADs. This study indicates more effective individualized treatment regimen is needed for most patients.
出处
《中华糖尿病杂志》
CAS
2012年第8期474-478,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病
2型
口服降糖药
胰岛素
血糖控制
Diabetes mellitus, type 2
Oral anti-diabetic drugs
Insulin
Glycemic control
