Analysis On Glycemic Control And Influencing Factors Of Type 2 Diabetes Mellitus Patients With Insulin Therapy In Tianjin

Objective: To understand the demographic characteristics among people suffering type 2 diabetes mellitus(T2DM)with insulin therapy in Tianjin,a cross-sectional study of 20 hospitals in Tianjin was conducted from 2015 to 2016.The outpatients with T2 DM were interviewed with a structured questionnaire,aiming to explore the current status of glycemic control and its influential factors and provide related evidence for secondary prevention of T2 DM.Methods: In this study,20 secondary and tertiary hospitals were randomly selected as research centers.The top 5 eligible T2 DM outpatients according to the inclusion and exclusion criteria were asked to conduct questionnaires,physical measurements,and laboratory tests.The content of this survey included the basic information,related factors of diabetes and its treatment,blood glucose level and blood lipid level.The influencing factors of good glycemic control among the T2 DM patients were analyzed using Lasso regression and Logistic regression methods.Results: A total of 2 791 T2 DM patients were included in this study,within which 1532(54.9%)were males.The median age of these patients was 56(IQR=14)years and 2 698 cases were married.(1)Among all the patients,1 905(31.7%)cases were with central obesity and others were not;1 086(38.9%)experienced family history of diabetes and 1 409(50.5%)cases suffered from diabetes related complications.According to the duration of disease,all the subjects were divided into 3groups,with 48.2%(<5 years),32.0%(5-10 years)and 19.8%(>10 years)of the subjects in each group.In terms of the duration of insulin treatment,the patients were divided into four group,with 778(≤0.5 years),818(0.5-1 years),661(1-3 years),and 534 cases(>3 years)in each group.Among all patients,2612 patients performed good adherence to their physicians by self-report.For lifestyle conditions,2174(77.9%)cases accustomed to regular exercise;2408(86.3%)patients changed their dietary habits after the diagnosis of type 2 diabetes;1 096(39.3%)subjects had smoking history and 897(32.1%)subjects had drinking history.As for the level of blood lipids,only 38.7%(1 079 cases)of the subjects reached the total cholesterol(TC)target;71.7%(2 000 cases)of the subjects failing to control the TG level in thenormal range;the number of patients who controlled the level of HDL-C andLDL-Cunder good condition were 1 801(64.3%)and 1 306(46.8%),relatively.(2)The median HbA1 c level was 7.4%,and only 29.0% of patients reached the HbA1 c target.Chi-square test was applied to compare the status of glycemic control among different groups.The results revealed that the rate of good glycemic control was significantly different among different groups according to age,marital status,BMI,central obesity,family history,T2 DM duration,duration of insulin treatment,TC level,TG level,exercise situation,diet,drinking history and dose of insulin injection(P<0.05).(3)Furthermore,the multivariate logistic and Lasso regression analysis showed that poor control of TC and TG,higher insulin doses,overweight,obesity,central obesity and aged over 45 years were the risk factors for good glycemic control of T2 DM patients;while regularly exercise,adjustment of dietary habits,diabetes family history,longer duration of insulin treatment were the protective factors for good glycemic control of T2 DM patients.After using MSE as a model evaluation index to assess the performance of the two models,the results displayed that compared with Logistic regression model,the Lasso regression model had a smaller MSE,indicating that the prediction accuracy of Lasso regression was higher,and it was applicable to analyze the influencing factors of glycemic control among T2 DM patients.Conclusion: The proportion of good glycemic control in 2791 T2 DM patients of present investigation was only 29.0%(810 cases).To improve glycemic control and prognosis of T2 DM patients,further health promotion activities should pay more attention on those vulnerable individuals such as patients with poor control of TC and TG,higher insulin doses,overweight,obesity,central obesity and aged over 65 years.Meanwhile,health extension workers should promote health education about diabetes related knowledge and risk factors of good glycemic control among T2 DM patients in order to enhance their understanding of the disease,which would in turn improve the health related quality of life among T2 DM patients.