The Status Of Blood Glucose Control And Drug Therapy In Patients With Type 2 Diabetes Mellitus In Shanghai

Diabetes is a metabolic disorder prevalent in Chinese urban population, with a wide range of adverse impacts on life expectancy and quality of life. To prevent diabetes-related chronic complications, effective management of blood glucose is vital. Diabetes management and education is a major task of public health for chronic conditions in Shanghai. Therefore, it's necessary to learn the status of glycemic control and to identify its related influencing factors. The survey will help improve community diabetes prevention and surveillance.ObjectiveTo evaluate the level of optimal control of HbAlc, hypertention, and hyperlipidemia, learn the medications and identify potential risk factors in patients with type 2 diabetes mellitus in Shanghai, China.MethodsA questionnaire survey and physical examination were conducted in 1642 type 2 diabetic patients from 210 communities through a random sampling method. The criteria of American Diabetes Association (ADA) and China Diabetes Society (CDS) were applied to evaluate the control of blood glucose, blood pressure, blood lipid, and medications. Based on the HbAlc target of HbAlc<7.0% recommended by ADA, patients were defined as adequately controlled or inadequately controlled. Logistic regression analysis was used to analyze factors that affect glycemic control.Results1. Control of HbAlc, hypertention, and hyperlipidemiaThe average fasting plasma glucose (FPG) was 7.9±2.8 mmol/L, with a mean value of HbAlc 7.5±1.7%. Percentage of patients achieving target goals promulgated by CDS were 27.8% for HbAlC(<6.5%),14.3% for blood pressure(<130/80 mmHg),25.4% for LDL-C(<2.5 mmol/L),49.0% for TG(<1.5 mmol/L), and 84.7% for HDL-C (>1.0 mmol/L), respectively. Only 5.1% patients achieved target HbAlc, BP and LDL-C. There were 43.6% patients whose HbAlc is less than 7.0%, among which only 9.9% met all ADA recommended target goals (HbAlc<7.0%, BP<130/80 mmHg, LDL-C<2.6 mmol/L). 2. MedicationsAbout 8.3% patients did not receive any treatment, while 46.8% were treated with one drug, and 44.9% a combination of two or more. The most used drugs for type 2 diabetes were sulfonylurea (64.1%), metformin (43.1%), and insulin (17.5%). There was a difference in drugs options between urban and suburban area. Sulfonylurea, metformin (43.1%), and a-glucosidase inhibiors were the top 3 drugs used in the downtown, but in the suburb were sulfonylurea, metformin, and insulin. Percentages of patients taking insulin were 20.3% in the urban group and 15.1% in the suburb. More urban patients adjusted their treatment plan in top first-class hospitals.3. Risk factorsMultivariate logistic regression analysis showed that age, residence, disease duration, medical nutrition therapy (MNT) band wais-to-hip ratio were factors associated with glycaemic goal achievement. Their corresponding odds ratios (OR) with 95% confidence intervals (CI) were 0.854 (0.753-0.969),0.765 (0.601-0.974),0.746 (0.606-0.919),1.519 (1.353-1.705), and 1.489 (1.276-1.737), respectively. Patients who are elder, live in urban area, and receive MNt were more likely to have a better glycaemic control. ConclusionThe main medications for patients with type 2 diabetes in Shanghai were the same as the treatment recommendation of ADA and European Association for the Study of Diabetes (EASD). The percentage of optimal control of HbAlc, hypertention, and hyperlipidemia was not satisfactory. Glycemic control was associated with age, residence, disease duration, MNT, and wais-to-hip.