云南5家三甲医院老年2型糖尿病患者血糖控制现状及影响因素

目的了解云南三甲医院老年2型糖尿病（T2DM）患者糖化血红蛋白（HbA1c）达标现状及其影响因素。 方法于2015年10月至2016月5月，选取云南5家三甲医院老年T2DM患者151例作为研究对象，进行人口学信息、体质量指数（BMI）、血糖、血压的数据统计，评估血糖控制情况，分析其影响因素。采用单因素方差分析比较不同年龄阶段组间空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）的差异，采用t检验比较不同文化程度组之间、不同BMI组之间、不同糖尿病病程组之间、不同血压组之间FPG、2 h PG及HbA1c的差异。 结果年龄（73.4±7.4）岁，病程（11.4±8.0）年，HbA1c（8.8±2.2）%，HbA1c<7.0%的患者29例（19.2%，29/151），BMI（24.3±3.6）kg/m²，BMI<24 kg/m²的患者占50.3%（76/151），FPG<7.0 mmol/L占33.1%（50/151），2 h PG<10.0 mmol/L占23.8%（36/151）；按年龄60~69岁、70~79岁、≥80岁分组，HbA1c组间比较［（8.1±2.0）% vs （8.9±1.8）% vs （9.2±2.5）%］，差异具有统计学意义（F=3.711，P=0.027）、2 h PG组间比较［（11.6±3.1）mmol/L vs （14.9±5.0）mmol/L vs （14.4±5.7）mmol/L］，差异具有统计学意义（F=5.829，P=0.004），FPG组间比较［（7.7±2.6）mmol/L vs （9.5±3.6）mmol/L vs （9.3±3.4）mmol/L］，差异无统计学意义（F=2.948，P=0.056）；初中及以下组及高中及以上组间，HbA1c组间比较［（9.0±2.2）% vs （8.2±2.0）%］，差异具有统计学意义（t=2.269，P=0.025），FPG、2 h PG组间比较，差异无统计学意义（P>0.05）；按照BMI<24 kg/m²、≥24 kg/m²分组，HbA1c、FPG、2 h PG组间差异均无统计学意义（P>0.05）；按照血压是否达标，HbA1c、FPG、2 h PG组间差异均无统计学意义（P>0.05）。按照糖尿病病程<10年、≥10年分组，HbA1c、FPG、2 h PG组间差异均无统计学意义（P>0.05）。 结论云南5家三甲医院老年T2DM患者血糖控制与年龄、文化程度有关，随着年龄增加血糖控制较差，文化程度越高，血糖控制越好。BMI、血压、糖尿病病程对血糖控制影响不明显。

Current status and influencing factors of glycemic control in elderly patients with type 2 diabetes mellitus in five third-grade class-A hospitals in Yunnan

ObjectiveTo investigate the status of glycosylated hemoglobin (HbA1c) and its influencing factors in elderly patients with type 2 diabetes mellitus (T2DM) in third-grade class-A hospitals in Yunnan Province, China. MethodsFrom October 2015 to May 2016, 151 elderly patients with T2DM at five third-grade class-A hospitals in Yunnan were selected as subjects for analysis of demographic information, body mass index (BMI), blood glucose, and blood pressure. Assessment of blood glucose control and analysis of its influencing factors. One-way ANOVA was used to compare the differences of fasting blood glucose (FPG), postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c) in different age groups. t-test was used to compare the differences of FPG, 2 h PG and HbA1c between different education groups, different BMI groups, different diabetic course groups and different blood pressure groups. ResultsThe patients included had a mean age of (73.4±7.4) years, course of disease of (11.4±8.0) years, and glycosylated hemoglobin (HbA1c) of (8.8±2.2)%. The percentage of patients with HbA1c<7.0% was 19.2%. The patients had a mean BMI of (24.3±3.6) kg/m², and the percentage of patients with a BMI<24 kg/m² was 50.3%. Patients with fasting blood glucose (FPG)<7.0 mmol/L accounted for 33.1%, and those with postprandial 2 h blood glucose (2 h PG)<10.0 mmol/L accounted for 23.8%. According to age (60 to 69 years, 70 to 79 years, and≥ 80 years old), there were statistically significant differences in HbA1c (8.1±2.0)% vs (8.9±1.8)% vs (9.2±2.5)%, F=3.711, P=0.027] and 2 h PG (11.6±3.1) mmol/L vs (14.9±5.0) mmol/L vs (14.4±5.7) mmol/L, F=5.829, P=0.004] among the three groups, although there was no significant difference in FPG (7.7±2.6) mmol/L vs (9.5±3.6) mmol/L vs (9.3±3.4) mmol/L, F=2.948, P=0.056]. According to the degree of education (junior high school and below vs high school and above), HbA1c differed significantly between the two groups (9.0±2.2)% vs (8.2±2.0)%, t=2.269, P=0.025], although there was no significant difference in FPG or 2 h PG (P>0.05). There were no significant differences in HbA1c, FPG, or 2 h PG according to BMI (<24 kg/m² vs ≥24 kg/m²), blood pressure (normal vs high), or duration of diabetes (<10 years vs ≥10 years) (P>0.05). ConclusionThe blood glucose control of elderly T2DM patients in the five third-level first-class hospitals in Yunnan is related to age and education level. With the increase of age, the blood glucose control is poor, and the higher the education level, the better the blood glucose control. BMI, blood pressure, and the course of diabetes have no significant effect on blood glucose control.