Glycosylated hemoglobin control and its influencing factors amongpatients with type 2 diabetes mellitus in rural communitiesof Zhejiang Province
ZHOU Xiaoyan, HU Ruying, HE Qingfang, PAN Jin, GONG Weiwei, LU Feng, WANG Meng, ZHONG Jieming
Department of Non-communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Controland Prevention, Hangzhou, Zhejiang 310051, China
Abstract：Objective To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities. Methods Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model. Results A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients. Conclusion The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.
周晓燕, 胡如英, 何青芳, 潘劲, 龚巍巍, 陆凤, 王蒙, 钟节鸣. 浙江省农村2型糖尿病患者糖化血红蛋白控制水平及影响因素分析[J]. 预防医学, 2022, 34(2): 123-128.
ZHOU Xiaoyan, HU Ruying, HE Qingfang, PAN Jin, GONG Weiwei, LU Feng, WANG Meng, ZHONG Jieming. Glycosylated hemoglobin control and its influencing factors amongpatients with type 2 diabetes mellitus in rural communitiesof Zhejiang Province. Preventive Medicine, 2022, 34(2): 123-128.
[1] International Diabetes Federation.IDF Diabetes Atlas-8th edition[R/OL].2017(2018-11-11)[2021-12-23].http://www.diabetesatlas.org/IDF_Diabetes_Atlas_8e_interactive_EN. [2] LI Y,TENG D,SHI X,et al.Prevalence of diabetes recorded in mainland China using2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J/OL].BMJ,2020,369(997)[2021-12-23].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186854.DOI:10.1136/bmj.m997. [3] 邓茜,张梅,黄正京,等.全国疾病监测点35岁及以上糖尿病患者管理现状研究[J].中华流行病学杂志,2016,37(9):1191-1195. DENG Q,ZHANG M,HUANG Z J,et al.Management of diabetes patients aged ≥35 years in disease areas in China[J].Chin J Epidemiol,2016,37(9):1191-1195. [4] SPITZ A F,KANANI H.Change in HbAlc as a measure of quality of diabetes care[J].Diabetes Care,2006,29(5):1183-1184. [5] 陈丽丽,程旻娜,严青华,等.上海市≥35岁自报糖尿病患者血糖控制现状与影响因素分析[J].中国慢性病预防与控制,2018,26(11):818-821. CHEN L L,CHENG M N,YAN Q H,et al.The diabetes control status and influencing factors among patients with self-reported diabetes(≥35 years old)in Shanghai[J]. Chin J Prev Control Chron Dis,2018,26(11):818-821. [6] XU F,HE J,WANG Z,et al.The relationship between socio-economic status and diagnosed type 2 diabetes is changing with economic growth in Nanjing,China[J].Diabet Med,2018,35(5):567-575. [7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华内分泌代谢杂志,2021,37(4):311-398. Chinese Diabetes Society.Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edtion)[J].Chin J Endocrinol Metab,2021,37(4):311-398. [8] 中华人民共和国卫生部.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006. Ministry of Health of the People's Republic of China. Guidelines for the prevention and control of overweight and obesity in adults in China[M].Beijing:People's Medical Press,2006. [9] 苏健,覃玉,沈冲,等.江苏省社区管理2型糖尿病患者综合控制情况分析[J].中华内分泌杂志,2018,34(2):112-120. SU J,QIN Y,SHEN C,et al.On the achievement of comprehensive control targets among type 2 diabetic patients managed by communities in Jiangsu province[J]. Chin J Endocrinol Metab,2018,34(2):112-120. [10] 杨群娣,阮晔,黎衍云,等.上海市社区管理2型糖尿病患者的血糖、血压及血脂控制情况分析[J].中国慢性病预防与控制,2015,23(8):561-564. YANG Q D,RUAN Y,LI Y Y,et al.The control of blood glucose,blood pressure and blood lipid among type 2 diabetes mellitus patients managed by communities in Shanghai city[J].Chin J Prev Control Chron Dis,2015,23(8):561-564. [11] 杨群娣,李锐,阮晔,等.上海市2型糖尿病患者的血糖控制的影响因素分析[J].环境与职业医学,2010,27(6):333-336. YANG Q D,LI R,RUAN Y,et al.Analysis on influencing factors for achieving glycemic control in patients with type 2 diabetes mellitus in Shanghai[J].J Environ Occup Med,2010,27(6):333-336. [12] 苏华林,孙彦文,黄俊,等.社区糖尿病人血糖控制及影响因素分析[J].疾病控制杂志,2006,10(2):148-150. SU H L,SUN Y W,HUANG J,et al.Analysis on the blood glucose control and its influencing factors in DM patients in communities[J].Chin J Dis Control Prev,2006,10(2):148-150. [13] 刘仕俊,袁寒艳,姜彩霞,等.杭州市老年高血压患者血压控制的影响因素研究[J].预防医学,2021,33(7):660-664. LIU S J,YUAN H Y,JIANG C X,et al.Influencing factors for blood pressure control in elderly patients with hypertension in Hangzhou[J].Prev Med,2021,33(7):660-664. [14] 胡如英,王勇,何青芳,等.浙江省农村2型糖尿病患者血脂异常及影响因素分析[J].预防医学,2020,32(7):649-654. HU R Y,WANG Y,HE Q F,et al.Prevalence and influencing factors of dyslipidemia among patients with type 2 diabetes mellitus in rural communities of Zhejiang Province[J].Prev Med,2020,32(7):649-654. [15] SNOW V,WEISS K B,MOTTUR-PILSON C.The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus[J].Ann Intern Med,2003,138(7):587-592. [16] VERGES B.Pathophysiology of diabetic dyslipidemia:where are we?[J].Diabetologia,2015,58(5):886-899. [17] 何静,叶青,王志勇,等.南京市社区2型糖尿病并发高血压患者糖化血红蛋白控制情况及影响因素[J].职业与健康,2018,34(6):847-850. HE J,YE Q,WANG Z Y,et al.Control status of glycosylated hemoglobin and its influencing factors among type 2 diabetes patients with hypertension in community of Nanjing City[J]. Occup Health,2018,34(6):847-850.
