| The number of diabetic increased rapidly in China, the management of these patients has become a tough medical and social problem. Diabetes is a chronic lifelong disease, glycemic control plays an important role in the prevention of chronic complications of diabetes. Community management and self-management has an important influence on glycemic control in patients. It is necessary to learn the status of management and glycemic control, to estimate the prevalence of chronic complications, to identify the related influencing factors. This research can provide a scientific basis for diabetic patients in community management and prevention strategies. ObjectiveThrough a cross-sectional study on the patients of type2diabetes in community management system, to describe the status of community management and self-management, to evaluate the level of diabetic control, including glycemia, hypertention, and hyperlipidemia, and to identify potential risk factors of socio-demographic, diabetic duration, and comprehensive management of type2diabetes control. MethodsA cross-sectional study was conducted in735type2diabetic from10communities of Putuo District through a systematic sampling method. Statistical analysis was used to assess the status of community management and self-management, glycemic control and prevalence of chronic complications. Logistic regression analysis was used to analyze the risk factors that affect glycemic control. Results1. The status of integrated managementAmong the735patients,78.5%of them aged60or older, the median of diabetic duration was10years. Patients showed clinical symptoms accounted for70.7%, and patients with chronic complications accounted for44.4%. Most of patients took oral hyperglycemic agents and21.3%had insulin injected. The proportion of patients accepting insulin therapy increased with prolong of diabetic duration (x,2=49.168, P<0.001).16.1%diabetic had their blood glucose monitoring once a week and13.5%had HbAlc examined4times or more per year.69.4%diabetic complied with diet control and58.1%with regular exercise.90.7%of the patients reported that they were knowledgeable about clinical symptoms of diabetes and78.6%reported they learned about chronic complications, but the awareness rate of HbAlc was24.6%.92.9%patients complied with doctor’s advice on medication.49.5%diabetic accepted standardized follow-up and91.2%of them educated by a doctor.2. Control of HbAlc, hypertention, and hyperlipididemiaThe average fasting plasma glucose (FPG) was7.66±2.50mmol/L, and the mean value of Hbalc was7.60±1.53%. According to the Shanghai Diabetes Prevention Guide,28.8%of the patients with the ideal control had FPG between4.1-6.1mmol/L while49.1%with poor FPG control (FPG>7.0mmol/L). Using the standard of HbAlc,23.7%diabetic with the ideal control had HbAlc<6.5%while40.8%with poor HbAlc control (HbAlc>7.5%). The proportion for patients achieving the ideal control target goals was18.0%for blood pressure,34.0%for TG,57.1%for TC,42.3%for HDL-C,25.0%for LDL-C,40.5%for BMI, and37.3%for WHR.3. Risk factorsUsing the standard of the ideal HbAlc control, K-W test showed that duration and insulin injected were factors associated with glycemic control. Adjusting for confounders such as gender, age, duration of drug use, multivariate analysis showed BMI(aOR=1.437,95%CI:1.002-2.060), WHR (aOR=1.417,95%CI:1.031-1.948), the time length of follow-up (aOR=1.016,95%CI:1.007-1.025), the times of follow-up (aOR=1.046,95%CI:1.030-1.062), and the normalization of follow-up (aOR=0.107,95%CI:0.074-0.153) were the potential risk factors.4. The prevalence of chronic complicationsAmong the patients,44.4%of them were diagnosed with at least one chronic complication. The prevalence of cardivacular and cerebrovasculer conditions, nephropathy, ocular lesions, foot disease and neuropathy were28.2%,11.3%,3.9%,17.6%,0.7%and2.0%. The overall prevalence of complications among female patients was significantly higher than in male patients (x2=4.594, P=0.032). The prevalence increased with age (x2=33.414, P<0.001) and duration (Χ2=23.213, P<0.001).ConclusionAmong the patients with type2diabetes in community management system of Putuo District, most of them were old people with long diabetic duration. Most of patients took oral hypoglycemic medication. The percentage of ideal control of HbAlc, hypertention, and hyperlipidemia was not satisfactory. The prevalence of chronic complications was high. The proportion of patients complied with diet control and regular exercise has not achieved the target goal. The community management of patients with type2diabetes needs to be improved. |
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