上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (1): 52-.doi: 10.3969/j.issn.1674-8115.2011.01.012

• 论著（临床研究） • 上一篇    下一篇

糖尿病患者失随访原因及代谢指标控制现状的调查

王丽华, 刘 伟, 周 峘, 吴培红, 董 莹, 滕香宇, 章 明, 贾 芸, 陈雅雯   

  1. 上海交通大学 医学院附属仁济医院内分泌科, 上海 200127
  • 出版日期:2011-01-28 发布日期:2011-02-01
  • 作者简介:王丽华（1975—）, 女, 主治医师, 博士生；电子信箱: lilyssmu@163.com。
  • 基金资助:

    上海市浦东新区社会发展局重点协作项目（PW-2008D-1）

Reasons for lost to follow-up and control status of metabolic parameters in patients with diabetes mellitus

WANG Li-hua, LIU Wei, ZHOU Huan, WU Pei-hong, DONG Ying, TENG Xiang-yu, ZHANG Ming, JIA Yun, CHEN Ya-wen   

  1. Department of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-01-28 Published:2011-02-01
  • Supported by:

    Shanghai Pudong New Area Social Development Bureau Foundation, PW-2008D-1

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摘要：

目的 了解三级医院糖尿病患者失随访原因；调查在社区医院就诊的糖尿病患者相关代谢指标的控制现状，并分析相关影响因素。方法 从上海交通大学医学院附属仁济医院内分泌科病历库中选取上海市浦东地区1年以上未就诊的2型糖尿病患者500例，通过问卷调查了解患者的流向、失随访原因及血糖监测情况；结合生化指标测定和问卷调查，评价在上海市浦东地区6家社区医院就诊的2型糖尿病患者的代谢指标控制情况，并分析相关影响因素。结果 共有392例（78.4%）患者完成失随访原因的问卷调查。调果结果显示：69.1%的患者流向社区医院；87.8%的患者近半年内有空腹血糖测定值；44.9%的患者有餐后2 h血糖测定值，20.2%的患者有糖化血红蛋白（HbA1c）测定值。在900例社区医院糖尿病患者中，HbA1c＜6.5%的患者占18.3%，收缩压/舒张压＜130 mmHg/80 mmHg的患者占17.4%，总胆固醇、低密度脂蛋白和高密度脂蛋白达标的患者分别占29.6%、31.6%和82.25%。相关分析显示：病程长、合并腹型肥胖、家庭收入低、监测血糖频率低与血糖控制不良有关。结论 三级医院和社区医院联动组成管理网络，可能是提高糖尿病患者管理效果的重要途径。

关键词: 2型糖尿病, 管理, 控制现状, 相关因素

Abstract:

Objective To explore the reasons for the lost to follow-up of patients with diabetes mellitus in a municipal hospital, investigate the control status of related metabolic parameters of patients with diabetes mellitus treated in community hospitals, and analyse the related influential factors. Methods Five hundred patients with type 2 diabetes mellitus in Pudong New Area absent from follow-up of a municipal hospital were selected, and their recent places for treatment, reasons for lost to follow-up and status of blood glucose monitoring were investigated by questionnaire survey. On the basis of results of biochemical examinations and questionnaire survey, the control status of metabolic parameters of patients with type 2 diabetes mellitus treated in 6 community hospitals in Pudong New Area was evaluated, and the related influential factors were analysed. Results A total of 392 patients (78.4%) finished the questionnaire. The questionnaire survey revealed that 69.1% of patients transferred to community hospitals for further treatment, 87.8% monitored fast blood glucose in the past 6 months, and 44.9% and 20.2% monitored postprandial blood glucose and glycosylated hemoglobin (HbA1c), respectively. Among the 900 patients with diabetes mellitus treated in community hospitals, those with HbA1c＜6.5% and systolic/diastolic blood pressure＜130 mmHg/80 mmHg accounted for 18.3% and 17.4%, respectively, and 29.6%, 31.6% and 82.25% of patients had normal levels of total cholesterol, low density lipoprotein and high density lipoprotein, respectively. Correlation analysis demonstrated that long disease course, abdominal obesity, low family incomes and low frequency of blood glucose monitoring were related to poor control of blood glucose. Conclusion Comprehensive treatment by municipal and community hospitals may be an effective way to improve the management effect for patients with diabetes mellitus.

Key words: type 2 diabetes mellitus, management, control status, related factors