| Objective: To vertically analyze the association of antidiabetic drugs adjustment withreaching target glucose in type2diabetic patients under management for three years inBeijing communities.Methods: In total,3201patients with type2diabetes aged more than20years from15community health service centers in Beijing were enrolled in August2008.Theirdemographic data，patterns of antidiabetic treatment, blood glucose(BG), bloodpressure, blood lipid and other clinical datas were collected after entering thecommunity hypoglycemic management program. With the guide of the standards ofmedical care in type2diabetic patients, the doctors adjusted antiglycemic drugs forrecommended BG from2008to2011. According to the adjustment of glucose-loweringdrugs by intervention for three years, all the T2DM patients surveyed were divided intofour groups:255(8.0%) added insulin intervention,641(20.0%) added oralhypoglycemic drugs（OHA）,1621(50.6%)used the same hypoglycemic drugs all thetime and684(21.4%) reduced antidiabetic drugs during the management.Results:①Four groups of patientswere with a reduction in HbA1c respectively from（8.3±1.9）%、（7.4±1.7）%、（6.8±1.3）%、（7.2±1.5）%dropped to （7.5±1.5）%（t=5.38,P＜0.01）、（7.0±1.3）%（t=5.17,P＜0.01）、（6.7±1.2）%（t=2.62,P＜0.05）'（7.1±1.4）%（t=1.76,P＞0.05）; the rates of patients reaching the HbA1c target（HbA1c＜7%）were rosen from25.9%（66/255）、51.6%（331/641）、71.0%（1151/1621）、54.5%（373/684）to43.5%（111/255）（χ2=16.71,P＜0.01）、63.0%（404/641）（χ2=16.99,P＜0.01）、74.5%（1208/1621）（χ2=5.06,P＜0.05）、60.2% （412/684）（χ2=4.78,P＜0.05）；the proportion of patients with a decrease in HbA1c＞0.5%unit was52.2%(133/255)、34.3%(220/641)、24.6%(399/1621)'31.9%(218/684), separately. In sum, Patients showing long-time reduction in HbA1cfrom2008to2011were more often treated with adding insulin during the management.②In the3-year analysis of3201type2diabetic patients, followed from2008to2011,there were1573patients with HbA1c<7%at baseline and at follow-up. And in thesepatients,985patients had changed their patterns of antidiabetic treatment; There were562patients who were showing an decrease in HbA1c from≥7%at baseline to <7%atfollow-up. And the highest proportion of the patients who were adding oralhypoglycaemic agents(OHA) reached the HbA1c target(48.4%).③By management for3years,the rates of patients with the HbA1c target in different educational background(from low to high)were from52.9%（294/556）、60.4%（1095/1814）、64.0%（532/831）to61.5%（342/556）（χ2=8.46,P＜0.01）、64.7%（1174/1814）（χ2=7.34,P＜0.01）、74.5%（619/831）（χ2=21.39,P＜0.01); while in different economic level(from low tohigh) from59.1%（987/1670）、60.7%（650/1071）、58.0%（119/205）to58.1%（971/1670）（χ2=0.32,P>0.05）、77.3%（828/1071）（χ2=69.15,P＜0.01）、66.8%（137/205）（χ2=3.37,P＜0.05）, respectively.④Logistic multi—regression analysisshowed that adding insulin,adding OHA, per capita income2000-4000￥/M,change ofBMI during the period, systolic pressure(SBP), age were independent factors for adecrease in HbA1c, with odds ratio (OR) of2.21、1.23、1.41、1.04、1.01'0.99.Conclusions：By management hypoglycemic drugs actively,Patients with type2diabetes in Beijing communities showed significant improvement in HbA1c from2008to2011, and were more often treated with adding insulin than other treatment patterns.Low-literacy and low-income groups were still the primary focus. |
PDF Full Text Request