Analysis On Current Status Of Glycemic Control And Its Influencing Factors Among Type 2 Diabetic Patients In Shanghai Communities

Objective:In this study,we conducted a cross-sectional survey of blood sugar control among randomly selected patients with T2 DM in representative communities in Shanghai to understand the Hb A1 c control status and control rate among patients with different demographic characteristics,and to analyze the influencing factors on blood sugar control status.Methods:Patients with T2 DM were selected by systematic random sampling method and investigated by "face-to-face" interview from two communities in Shanghai.The questionnaire covers the general demographic characteristics,disease-related information,diabetes related cognition,behavior management supported by medical staff,self-management behaviors,social psychological characteristics,etc.At the same time,the height,weight and Hb A1 c were measured.The results of Hb A1 c were used as the evaluation criteria for the effect of blood sugar control.After the questionnaires had been sorted,Epi-data 3.02 software was used for the establishment of database,SPSS23.0 were used for statistical analysis.Results:(1)A total of 362 patients T2 DM were investigated,the average value of Hb A1 c was(7.27 +1.33)%.The control rate of Hb A1 c was 48.9%.The proportion of patients with at least one or more chronic complications/comorbidities was 70.7%.The prevalence of diabetic retinopathy complications in female patients was higher than that in male patients(P < 0.05).(2)The total score of diabetes related cognition was(9.33 +3.09).The cognition rates were relatively low on the type of diabetes(12.7%),harm of salty food(35.4%)and diagnostic criteria(52.8%),etc.Age and education level were correlated with the total score of diabetes cognition(P < 0.05).(3)The total score of behavior management supported by medical staff was(6.07±2.91),families with low education level and poor economic status received significantly insufficient behavioral management support from medical staff.(4)The average total score of SDSCA was(33.28 +13.60).It was related to marital status,course of disease,education level,family economic status,diabetes cognitive level and behavior management supported by medical staff(P < 0.05).The lower dimension scores of SDSCA included foot care,blood sugar monitoring and exercise,et al.(5)The average PAID score of patients was(32.30 +14.89).The abnormal rate of psychosocial characteristics and serious abnormal rate were 34.5% and 26.8% respectively.The abnormal rate of psychosocial characteristics was related to education level,course of disease,complications/comorbidities(P < 0.01).(6)The Hb A1 c level was correlated with age,marital status,BMI,course of disease,total score of diabetes cognition,total score of behavior management supported by medical staff,total score of SDSCA and total score of PAID(P < 0.05).The factors that might increase the failure rate of Hb A1 c control included the level of monthly income of family per capita(OR = 1.543),abnormal social psychological characteristics(OR = 38.375),over 80 years old(OR = 3.487),family history of diabetes mellitus among first-degree relatives(OR=2.383),while the factors that may reduce the failure rate of Hb A1 c control included good status on self-behavior management(OR=0.204)and behavior management supported by medical staff(OR=0.885).Conclusion:The glycemic control level of type 2 diabetes mellitus still needs to be improved among type 2 diabetic patients in Shanghai communities.The influencing factors which can be intervened included patient’s social psychological characteristics,self-behavior management ability and behavior management supported by medical staff.Other influencing factors included course of disease,age,family economic status,family history of diabetes mellitus among first-degree relatives,etc.In addition,the diabetes related cognition may play an indirect effect on blood glucose control.Continuous strengthening on the behavioral management support by patients themselves and medical staff,paying attention to the discovery of psychological problems and carrying out individual mental health intervention,and improving diabetes cognitive defects may help to improve the rate of Hb A1 c control.