| Objective To analyze the status of blood glucose control in patients with type 2diabetes,explore its influencing factors and thresholds,and evaluate the effects of different hypoglycemic drugs on blood glucose control before admission.Methods Based on the management platform of Diabetes Health Management Center of Shijiazhuang Second Hospital,6182 patients with type 2 diabetes were selected as the research objects from January 2016 to May 2021.Firstly,the characteristics and correlation of comorbidity and hypoglycemic drugs were described by association rules analysis,and the status of blood glucose control in different characteristics population was described and analyzed.Secondly,logistic regression model and regression discontinuity design model were used to explore the influencing factors and the threshold of blood glucose control.Finally,the uplift model was used to evaluate the hypoglycemic effects of different hypoglycemic drugs after using the propensity scoring method to balance and compare the characteristics of hypoglycemic drug users and non-users.Results1.Among 6182 patients with type 2 diabetes,hypertension(47.80%),hyperlipidemia(36.77%)and fatty liver(28.47%)were the three most common diseases.There were different degrees of correlation between comorbidities,among which the co-prevalence rates of hyperlipidemia and hypertension(22.63%),hyperlipidemia and fatty liver(17.92%),hypertension and coronary heart disease(17.68%)were the highest.2.Biguanides(46.68%),insulins(30.33%),glucosidase inhibitors(25.54%)and sulfonylureas(15.69%)were the highest usage rate.Most hypoglycemic drugs were used together.Biguanides+glucosidase inhibitors(16.16%),biguanides+insulins(12.31%),biguanides+sulfonylureas(10.51%)and insulins + glucosidase inhibitors(8.51%)were the most in the combination drugs.The highest used triple drug was biguanides+insulins+ glucosidase inhibitors(4.80%).3.Among 6182 type 2 diabetes patients,1869(30.23%)had a good glycemic control,including 904(28.94%)males and 965(31.56%)females.There were differences in glycemic control rates among groups with different dietary control,exercise status and family history of diabetes(P(27)0.05).The blood glucose control rates of patients with strict dietary control,regular exercise,and without family history of diabetes were 43.27%,31.96% and 31.14%,respectively.The rates were different among the groups using different hypoglycemic drugs and those not taking drugs.The rate of those using glucosidase inhibitors was higher than that of those without hypoglycemic drugs(49.51% vs 39.30%).4.According to the influencing factors of blood glucose control,the risk of poor glycemic control in women was lower than that in men(OR=0.832,P<0.05).The longer the duration of diabetes was not conducive to blood glucose control(OR=1.022,P<0.05).The stricter the diet,the lower the risk of poor blood sugar control.The risk of poor blood glucose control was 1.532 times(95%CI:1.331～1.763),2.471 times(95%CI:1.989～3.069)and 2.659 times(95%CI: 2.169～3.259)in those using oral medications,insulin,and insulin combined with oral medications compared to those using no medications.The risk of poor glycemic control decreased by0.30%(OR=0.997)and 44.90%(OR=0.551)for each unit increase in UA and HDL-C.The risk of poor glycemic control increased by 18.20%(OR=1.182)and 11.60%(OR=1.116)for each unit increase in TC and TG.The threshold analysis showed significant changes in the risk of poor glycemic control at TC=8.0mmol/L and HDL-C=2.5mmol/L.The risk increased by 3.370%(P=0.016)at TC=8.0mmol/L and reduced by 9.830%(P=0.046)at HDL-C=2.5mmol/L.5.The results of evaluation of the effect of pre-hospital medication showed that770,536,197 and 151 subjects were enrolled using biguanides,insulins,glucosidase inhibitors and sulfonylureas alone after PSM matching.The uplift model analysis showed that maximum cumulative net effect of glycemic control could be achieved if the percentage of population using drugs were 0.30%,4.60%,13.80% and 78.70%,respectively.The cumulative net effect was 0.10%,0.37%,4.40% and 5.50%,respectively.After PSM matching,441,377,291 and 155 subjects were included using biguanides+glucosidase inhibitors,biguanides+sulfonylureas,biguanides +insulins,and insulins+glucosidase inhibitors.The uplift model analysis showed that maximum cumulative net effect of glycemic control could be achieved if the percentage of population using drugs were 44.50%,0.10%,44.40% and 69.20%.The cumulative net effect was 7.24%,0.30%,7.67% and 8.43%,respectively.After PSM matching,230 subjects enrolled using biguanides+insulins+glucosidase inhibitors.The cumulative net effect was 0.10% when the percentage of population using drugs was 0.01%.Conclusions1.Patients with type 2 diabetes mellitus were characterized by multiple diseases and comorbidities.Hypertension,hyperlipidemia and fatty liver were the key diseases in the comorbidity network.2.The use of hypoglycemic drugs in diabetic patients were complicated.Biguanides,insulins,glucosidase inhibitors and sulfonylureas had the highest usage rate.Biguanides+glucosidase inhibitors,biguanides+insulins,biguanides +sulfonylureas and insulins+glucosidase inhibitors were the most in the combination drugs.The highest used triple drug was biguanides+insulins+ glucosidase inhibitors.3.Blood glucose control rates were at a lower level in patients with diabetes.Patients with uncontrolled diet,no exercise,with a family history of diabetes and use of hypoglycemic drugs had a lower blood control rate.4.Gender,diet control,hypoglycemic drugs,age,duration of diabetes,UA,TC,TG and HDL-C were influencing factors of blood glucose control.The focus was on men,poor diet control,younger age,longer duration of diabetes and dyslipidemia.The attention shoud be paid to the control of blood sugar timely at TC~38.0mmol/L and HDL-C(?)2.5 mmol/L.5.The effect of hypoglycemic drugs on blood glucose control was not good in patients with diabetes before admission.The glycemic control rate of the patients using glucosidase inhibitors was higher than those not using drug.After balancing the influencing factors,the net effect of each drug on blood glucose control was less than 10%. |
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