| ObjectiveTo summarize the characteristics of hospitalized diabetic patients in different departments of Chinese PLA General Hospital and analyze the current status of the glycemic control,prevalence of chronic complications and comorbidities and antihyperglycemic treatment in different departments.MethodsThe clinical data of patients with diabetes admitted to Chinese PLA General Hospital between 2001.1 and 2014.5 were collected (the patients hospitalized in the department of endocrinology were excluded).10041 patients were selected by stratified random sampling. The visiting ages, sex, course of disease, biochemical data, chronic complications and comorbidities, the type of hypoglycemic medication regimen and agents in different departments and the variation on hypoglycemic treatment strategies after consulted by endocrinologists were retrospectively analyzed.Resultsl.A total number of 10041 patients with diabetes mellitus were selected,5502 male and 4539 female. The overall mean age was 61.9±13.6 years, and the cohort of patients with the age between 60 to 69 was largest among all decades. The average diabetic duration was 8.46±6.78 years. The patients’ was longer in surgical department than that in internal medicine wards.2.Of all the patients, the average fasting blood glucose was 7.67±3.32mmol/L and the average HbAlc was 7.41 ±1.61%. Among the 9800 patients with type 2 diabetes, only 44.0% attained the glycemic target of FBG in 4.4-7.Ommol/L, and 46.9% achieved the goal of HbAlc<7.0%. Of the 74 patients with type 1 diabetes,42.9% met the goal of HbAlc<7.0%. The glycemic control was better among patients in internal medicine compared to those in surgical department(P<0.001).During the past 15 years,the glycemic control was improving.3.The total rate of chronic complications and comorbidities was 87.3%. The prevalence of chronic diabetic complications and related concomitant disease were 63.7% for hypertension,31.8% for dyslipidemia,26.5% for malignant neoplasm, 25.9% for coronary heart disease,15.9% for cerebral infarction,12.6% for diabetic nephropathy,11.5% for infection,8.1% for diabetic retinopathy,5.1% for angina pectoris,4.5% for myocardial infarction,3.4% for diabetic neuropathy,1.6% for diabetic lower extremity arterial disease,1.5% for stroke,0.5% for diabetic foot. The total rate in internal medicine was much higher compared to those in surgical department(χ2=126.289, P<0.001). And the prevalence rate of chronic diabetic complications was higher in patients with type 1 diabetes.4.①Of 10041 patients,49.8% were treated with OADs alone,37.2% were using insulin only and there were 13.0% of the patients receiving OADs plus insulin. The majority of patients in internal medicine were treated with OADs, while those in surgical department preferred insulin(χ2=117.928, P<0.001). ②Metformin, alpha-glucosidase inhibitors, pre-mixed 30R and insulin glargine were more common than other AHA (anti-hyperglycemic agents).③Most of the patients in nephrology department were treated with insulin therapy. In department of internal medicine,the patients treated with metformin,alpha-glucosidase inhibitors,sulfonylureas and different types of insulin were more than that treated with other AHAs.④Several types of the treatment were used for the management of patients in surgical department. Insulin therapy was more performed in the ophthalmology and hepatobiliary surgery compared with other surgical departments. ⑤During the past 15 years, the number of patients treated with OADs alone reduced, while the number of those using insulin alone, or OADs plus insulin was increasing. Besides, the proportion of insulin,glinides, alpha-glucosidase inhibitors and thiazolidinediones was gradually increased, while the proportion of sulfonylureas and metformin was in decline.⑥After consulted by endocrinologists, the proportion of metformin, DPP-4 inhibitors and different types of insulin was gradually increased, while the proportion of sulfonylureas and alpha-glucosidase inhibitors was in decline.Conclusions1.More than half of the hospitalized diabetic patients did not achieve the glycemic target (HbAlc<7.0%), indicating that improvements in glycemic control were necessary.2.The chronic diabetic complications and related concomitant diseases were very common in hospitalized diabetic patients.3.Most of the patients were treated with OADs alone. Metformin,alpha-glucosidase inhibitor, pre-mixed 30R and insulin glargine were the most frequently prescribed agents in the inpatient wards.4.Among the patients in internal medicine, the number of using metformin, sulfonylureas,alpha-glucosidase inhibitors and different types of insulin for treatment was higher than that treated with other AHAs. While insulin therapy was more common in surgical department than internal medicine.5.During the past 15 years, the number of those using insulin alone, or OADs plus insulin was increasing. Besides, the proportion of insulin was gradually increased.6.The role endocrinologists played in the management of glycemic control was important. After consulted by an endocrinologist, the proportion of metformin, DPP-4 inhibitors and different types of insulin was gradually increased. |
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