| Objective:The first aim of the present study is to assess the current status of glycemic control, blood pressure levels, blood lipid levels and medications of type 2 diabetes (T2DM) patients in communities of Shanghai, and to find risk factors of optimal control of HbA1c. The second aim is to evaluate the quality of life of these T2DM patients, and to identify the potential risk factors of their QOL.Methods:2741 patients with T2DM who were managed in the communities in Shanghai were sampled through a cross-sectional study with the method of multistage stratified sampling. The study contents included the basic information of the disease, the indicators in SF-36 scale, physical examination, the tests of FBG, HbA1c, and blood lipid, The control level of BG, blood pressure, blood lipid and BMI, as well as the status about quality of life in these patients were evaluate based on the controlling target of’Guide of prevention and treatment of T2DM in China’(2010 version). Multivariate unconditional Logistic regression was applied to analyses the risk factors for the control of the HbA1c and the quality of life in T2DM.Results:The average age was 67.7±9.30 years in 2741 community patients with type T2DM, the sex ratio of men and women was 0.72:1, the ratio of urban and suburb was close to 1:1, and the course of disease was 8(5,13) years. The self-reported prevelance of chronic complications of T2DM, which including diabetic nephropathy, diabetic retinopathy, diabetic neuropathy and diabetic foot ulcers and gangrenosis, was 1.97%, 8.28%,1.82%, and 0.99%, respectively. The percentage of concurrent chronic diseases, such as coronary heart disease, cerebral stroke and HBP, was 17.22%,11.57% and 63.99%, respectively. There were 10.22% of these patients who do not take any medication. The proportion of the patients who took oral medication was 71.14% only, the patients who used insulin was 9.92%, and the patients who used both insulin and oral medication was 8.72%. The main reason for the lower adherence of taking medications and the medical advice was due to their ignoring of the medical treatment because of the asymptomatic.96.68% of the patients monitored their glycemic blood, and 46.81% tested their HbA1c levels in the last year.55.77% patients took exercises frequently in the past year, and 55.36% patients performed diet control strictly.1. The control situation of HbA1c, FBG, BP, blood lipid and BMI in T2DM patients in community of ShanghaiThe average level of HbA1c was (7.47±1.78)% in all the patients. 49.73% of the patients had a HbA1c level less than 7.0%, and 32.54% less than 6.5%. The average level of FBG was 7.98±2.47mmol/L, and the FBG in 47.83% of the patients was between 3.9-7.2mmol/L The compliance of FBG in T2DM in the urban area was higher than in the suburb area, and the average age in the compliant group was older than that in the incompliant group. The average level of blood lipid in the patients was:TC 5.27 ±1.19 mmol/L, HDL-C 1.36±0.34 mmol/L, LDL-C 3.07±0.80 mmol/L, TG 1.68 (1.15,2.48) mmol/L.69.72% patients met the target control level of HDL-C (men>1.9mmol/L, women>1.3mmol/L),24.08% of the patients met the target control level of LDL-C (patients with concomitant coronary heart disease < 2.6mmol/L, patients without concomitant coronary heart disease< 2.07mmol/L), and 50.35% patients met the target control level of TG(＜1.7mmol/L). The rate of reaching the target levels of HDL-C, LDL-C and TG in the male patients was higher than that in the female patients, and there was 11.64% of the patients who had these 3 items of blood lipid met the standards. The average systolic blood pressure was 134.54± 15.59mmHg, and the average diastolic blood pressure was 79.16±8.49mmHg. 21.23% of the patients met the target control level of blood pressure (<130/80mmHg), and the compliant rate of the patients in the urban area was higher than that in the suburb area. The average of BMI was 24.86 ±4.40kg/m2, and women had higher BMI than men.44.00% of the patients met the target control level of BMI (＜24kg/m2).2. The risk factors of HbA10 in T2DM patients in community of ShanghaiA multivariate analysis was performed to analyze the risk factors that reduced the HbA1c levels in community T2DM of Shanghai. The adjusted factors added into the model included age, gender, areas, monthly income per person in the family, disease course, family history of DM, chronic complications declaimed by the patients themselves, and the type of the drugs taken.In the past year, several factors helped decreasing the uncontrol level of HbA1c, which included the monitoring of HbA1c, performing diet control strictly, and taking exercises frequently, their ORs(95% CIs) were 0.72 (0.60,0.87),0.70 (0.50,0.96) and 0.75 (0.64,0.88), separately. While BMI, blood pressure, LDL-C, and TG increased the HbA1c level, the ORs(95% CIs) were 1.26(1.07,1.48),1.29(1.06,1.56),1.44(1.20,1.74) and 1.38(1.17,1.61), separately.3. The status and potential risk factors of QOL with T2DM patients in community of Shanghai The scores of each dimensions of PF, RP, BP, GH, VT, SF, RE and MH about quality of life were:85(65,95),100(75,100),90(74,90),62(42,75), 75(60,85),89(78,100),100(100,100)and 80(68,92), respectively. The score of body pain(BP) which reflected the physical function was lower than HongKong norming in the male patients aged from 41 to 64, and the damage was serious. The damage was similar in the dimensions of PF, BP and SF of the male patients aged 65 years and above when comparing to HongKong norming. The scores in the dimensions of GH, VT and MH in the male patients were higher than HongKong norming. There were no differences in the rest dimensions. In the female patients, the scores in PF and BP were lower than in HongKong norming, the scores in RP, RE, SF were close to HongKong norming, and the scores in GH, VT, MH were higher than HongKong norming.The results of multiple-factor non-conditional logistic regression model analysis in every dimension showed that some population sociological features, such as gender, living areas, age, educational levels, income, influence several or all of the dimensions of quality of life. Negative factors about the multiple dimensions of quality of life include chronic diseases, such as coronary heart disease, stroke, hypertetion, and chronic complications of T2DM. Regular exercises increased the score of all dimensions. Treatment with insulin plus oral medication was a negative factor to the dimensions of RP, GH, RE, their ORs(95% CIs) were 0.56(0.43,0.81),0.67(0.48,0.91)and 0.67(0.48, 0.94),respectively.Conclusion:Factors, such as diet control, physical exercise, BMI, control of blood pressure and blood lipid, affect the control level of HbA1c in the diabetics. Physical exercise increases the quality of life, and using insulin plus oral medication, having chronic complications and concomitant diseases decreased the quality of life in community T2DM patients. It is recommended to perform series of corresponding interventions to increase the control level of the HbA1c and quality of life in the diabetics. |
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