常州市武进区2型糖尿病患者糖化血红蛋白控制状况及其影响因素研究

目的 分析武进区糖尿病患者糖化血红蛋白（HbA1c）控制状况及其影响因素。方法 基于区域卫生信息系统，收集武进区2018年10月—2020年9月在管的2型糖尿病患者（T2DM）基本信息和糖化血红蛋白检测数据，采用多因素logistic回归分析影响糖化血红蛋白控制状况及其影响因素。结果 共11 644例数据完整的糖尿病患者纳入分析，男性5 016例，女性6 628例，HbA1c达标（＜7%）人数4 586人（39.39%）。不同年龄组（χ2 = 35.254，P＜0.001）、不同吸烟状态组（χ2 = 16.789，P＜0.001）、不同饮酒频率组（χ2 = 6.155，P = 0.046）、不同医保类型组（χ2 = 25.213，P＜0.001）、不同糖尿病病程组（χ2 = 71.716，P＜0.001）、不同体质指数组（χ2 = 11.518，P = 0.009）和不同季节（χ2 = 25.213，P＜0.001）达标率差异有统计学意义。多元logistic回归显示较高年龄组（以＜60岁组为参照，60～69岁组OR = 0.793，95%CI:0.710～0.884；70～79岁组OR = 0.642，95%CI:0.573～0.720；≥80岁组OR = 0.542，95%CI:0.466～0.630）、较高文化程度（以文盲为参照，初中组OR = 0.692，95%CI:0.517～0.927；高中及以上组OR = 0.619，95%CI:0.454～0.846）、城镇职工医保（OR = 0.844，95%CI:0.767～0.929）、秋季（OR = 0.829，95%CI:0.737～0.932）和冬季（OR = 0.861，95%CI:0.776～0.955）是HbA1c控制不达标的保护因素，吸烟（OR = 1.227，95%CI:1.091～1.381）和戒烟（OR = 1.434，95%CI:1.096～1.874）、超重（OR = 1.130，95%CI:1.040～1.228）和肥胖（OR = 1.144，95%CI:1.023～1.280）、较长糖尿病病程（以＜2年组为参照，2～5.9年组OR = 1.126，95%CI:1.015～1.248；6～7.9年组OR = 1.587，95%CI:1.432～1.758；≥8年组OR = 1.737，95%CI:1.540～1.958）是HbA1c控制不达标的危险因素。结论 武进区糖尿病患者糖化血红蛋白达标率低，尤其是低年龄、超重和肥胖、吸烟或戒烟、糖尿病病程长、文化程度低和城镇居民医保患者，应采取相应措施提高糖化血红蛋白达标率。

Glycosylated hemoglobin control and its influencing factors in patients with type 2 diabetes mellitus in Wujin district

To analyze the glycosylated hemoglobin (HbA1c) control status of diabetic patients in Wujin Districtand its influencing factors. Methods Based on the regional health information system, the basic information and the data ofHbA1c of T2DM patients were collected from October 2018 to September 2020 in Wujin district. Multivariate logistic regression was used to analyze the influencing factors of HbA1c control. Results A total of 11 644 T2DM patients with completedata were included in the analysis, including 5 016 males and 6 628 females, and the control rate of HbA1c was 39.39%.The control rates of HbA1c were statistically different in terms of age (χ2=35.254, P<0.001), smoking status (χ2=16.789, P<0.001), drinking frequency (χ2=6.155, P=0.046), medical insurance type (χ2=25.213, P<0.001), duration of diabetes mellitus(χ2=71.716, P<0.001), body mass index (χ2=11.518, P=0.009) and season (χ2=25.213, P<0.001). Multiple logistic regressionshowed that older age groups (using the <60 years group as reference, OR=0.793, 95%CI: 0.710-0.884 for the 60-69 yearsgroup; OR=0.642, 95%CI: 0.573 -0.720 for the 70 -79 years group; OR=0.542, 95%CI: 0.466 -0.630 for the ≥80 yearsgroup), higher literacy (using illiteracy as a reference, OR=0.692, 95%CI: 0.517-0.927 for the middle school group; OR=0.619, 95%CI: 0.454-0.846 for the high school and above group), urban employee health insurance (OR=0.844, 95%CI:0.767-0.929), fall (OR=0.829, 95%CI: 0.737-0.932) and winter (OR=0.861, 95%CI: 0.776-0.955) were protective factors forsubstandard HbA1c control, and smoking (OR=1.227, 95%CI: 1.091-1.381) and smoking cessation (OR=1.434, 95%CI:1.096-1.874), overweight (OR=1.130, 95%CI: 1.040-1.228) and obesity (OR=1.144, 95%CI: 1.023-1.280), longer duration ofdiabetes (using the <2 years group as reference, OR=1.126, 95%CI: 1.015-1.248 for the 2-5.9 years group and OR=1.587,95%CI: 1.432-1.758 for the 6-7.9 years group, OR=1.737, 95%CI: 1.540 to 1.958 for the ≥8-year group) were risk factorsfor substandard HbA1c control. Conclusion The glycosylated hemoglobin attainment rate in diabetic patients in Wujin District is low, especially in patients with young age, overweight and obesity, smoking or smoking cessation, long duration of diabetes, low literacy and urban residents with medical insurance, and appropriate measures should be taken to improve the glycosylated hemoglobin control rate