Correlation Of Self-management Levels With Diabetic Retinopathy And Levels Of Glycosylated Hemoglobin A1c In Patients With Type2Diabetes Mellitus In Gusu District, Suzhou

ObjectiveTo study the self-management levels and explore the correlation ofself-management levels with levels of hemoglobin A1c (HbA1c) and diabeticretinopathy (DR) in patients with type2diabetes(T2DM) in Gusu District, Suzhou.MethodsA community-based cross-sectional study was carried out in890T2DM patientsderived from four communities in Gusu district, Suzhou from April to May,2012. Theages of participants were35years old or more and the history of diabetes was at leastone year or longer. Questionnaire interview was conducted by trained surveyors usingstandard questionnaires to collect data on demographic characteristics and factorsrelated to self-management, disease duration, family history, diabetic microvascularcomplications. Fasting venous blood samples were obtained to test blood lipid, bloodglucose as well as HbA1c. Epidata3.2software was used to build the database; allquestionnaires were entered in double times and were checked after enter. SPSS16.0software was used for statistical analysis. The test level is alpha=0.05. A two-tailed Pvalue less than0.05was considered statistically significant. Logistic regression wasused to examine the association of self-management with level of GlycosylatedHemoglobin A1c and diabetic retinopathy.ResultsThe current study obtained890questionairs, effective888, including400malesand488females. The average age was62.4±9.0. The median disease duration was5years.There were211diabetic participants with diabetic retinopathy, and the prevalencewas23.8%. There were305diabetic participants with well-control GlycosylatedHemoglobin A1c(HbA1c<7%). The patients with DR tended to have a longer duration of diabetes [7(3-11)vs.5(2-9)year], a higher systolic blood pressure（140.0±16.1vs.137.0±16.9mmHg）and higher levels of fasting blood glucose（8.01±2.73vs.7.57±2.30mmol/L）and HbA1c（7.84±1.40vs.7.53±1.31,%）, compared with those without DR.The patients who know diabetes knowledge, exercise regularly, control diet, followdoctor’s advice and monitor blood glucose account for78%,17.2%,25.8%,19.5%and23.0%respectively.Well-control HbA1c was a protective factor for DR (OR=0.58,95%CI:0.41～0.83).After adjusted for age, gender, disease duration, family history of diabetes mellitus andother related self-management factors, logistic regression analysis showed thatHbA1c<7.0%was an important protective factor for DR,(OR=0.63(95%CI:0.44-0.91).Both univariate and multivariate analysis showed that other self-management relatedbehaviors such as smoking, drinking, diet control, regular physical exercises, bloodpressure well-control and lipid well-control and diabetic retinopathy had no significantcorrelation.After adjusted for age, sex, the duration of diabetes and drug therapy, binarylogistic regression analysis showed that following the doctor’s advice and examiningHbA1c every3-6months could help to improve glycemic control (OR=1.78,95%CI：1.14~2.51，P=0.01vs2.52,95%CI：1.60~4.00，P=0.000)；while overweight/obesity wasa risk factor for glycemic control（OR=0.66（95%CI：0.50~0.89，P=0.006）.ConclusionsThe self-management levels and glycemic control levels were both very low inthese patients in Gusu District. Effective measures should be taken to change patients’life style.Following the doctor’s advice and examining HbA1c every3-6months couldhelp to improve glycemic control, while overweight/obesity is a risk factor for glycemiccontrol.For T2DM patients, controlling HbA1c<7.0%may be an important protectivefactor to prevent DR. It is critical to controlling HbA1c to prevent diabetic retinopathy.