| Background and purpose: Diabetes mellitus is one of the most common endocrine and metabolic diseases,In 2010, the Chinese Center for Disease Control and prevention survey: to estimate the prevalence of diabetes in adults over 18 years of age in China is 11.6%[1], and the trend of younger.Cardiovascular and cerebrovascular disease is one of the most common chronic complications of diabetes, also the main cause of death,Its essence is atherosclerotic cardiovascular and cerebrovascular diseases.Mainly related to genetic factors, vascular endothelial dysfunction, insulin resistance and hyperinsulinemia, platelet activation and coagulation/fibrinolysis system abnormalities and other factors related to [2].Lipid metabolism disorder is the main factor to promote atherosclerosis, and is the main factor of the incidence and mortality of cardiovascular and cerebrovascular diseases,The results showed that the levels of total cholesterol, low-density lipoprotein cholesterol and triglyceride increased,but High density lipoprotein cholesterol decreased.Statins can effectively lower LDL cholesterol and increase high-density lipoprotein cholesterol levels, is the cornerstone of lipid-lowering therapy,and is considered as a key mechanism to realize the role of cardiovascular protection, the progress of intensive statin therapy scheme can effectively delay the coronary atherosclerosis, even to a certain extent reversed pre-existing atherosclerosis .A number of studies also confirmed that statins have a variety of purposes of improving vascular endothelial function, anti-inflammatory and antioxidant, stable plaques, even can significantly reduce cardiovascular events in patients with diabetes, play an important role in the prevention and treatment of cardiovascular complications in diabetes[3].With the development of medical science and the deepening of multi-disciplinary cooperation, the current understanding of the risk of dyslipidemia in patients with type 2 diabetes is increasing.There are also more lipid-lowering drugs available on the market, but the treatment of dyslipidemia has not been improved.Although the actual number of individuals receiving treatment increased, the number of patients who received the treatment but did not meet the recommended treatment targets.In our country, the level of blood lipid in type 2 diabetic patients,especially the low density lipoprotein, often can not reach the control level of the guideline,So as to noneffectively reduce the occurrence of cardiovascular and cerebrovascular events.Therefore, in order to further understand the situation of blood lipid control in type 2 diabetic patients and the application of statins.In 2010, led by Professor Ji Linong Peking University People’s Hospital,firstly research on “China cardiovascular metabolic diseases Registration study , CCMR"--Cardiovascular risk factors for type 2 diabetes mellitus in China: a national assessment of blood pressure, blood lipids and blood glucose(CCMR-3B STUDY )[4].A total of 98 patients with type 2 diabetes were surveyed in our hospital as a sub center of the southwest area.On the basis of this research, We analyzed the blood lipid control and the use of statins in type 2 diabetic patients in our country, so as to better control of blood lipids in patients with type 2 diabetes in China,to provide the corresponding medication guidance and improving measures.Methods in a multicenter cross-sectional study of CCMR-3B large-scale STUDY[5], from July 2010 to February 2011 in China’s 6 regions (North, northeast, northwest, East, South, southwest) of 104 hospitals were investigated in patients with type 2 diabetes, using questionnaire to collect clinical data, including gender, age the body mass index (BMI), the level of education, health care, income and fasting blood glucose, blood lipid, blood pressure, hemoglobin, serum creatinine, uric acid, urinary albumin / creatinine ratio, treatment history, and then aggregated into a database by means of statistics and analysis of Chinese patients with type 2 diabetes and statin lipid the drug was used in the study of related data. One of my school as a center of the southwest area were investigated in 98 patients with type 2 diabetes, due to less number of representative patients that is not high, so the research combined with the data of all 25454 patients of the CCMR-3B STUDY six regions were analyzed, using the status of my understanding of the type 2 diabetic patients to control blood lipids and the overall level of statins drugs, and for our patients with type 2 diabetes medication guide lipid control.Results(1) among the 25454 patients, the average age (62.6 + 11.83) years old, the average BMI (24.8 + 3.57) Kg/m2, glycosylated hemoglobin(HbAlc) average (7.6 + 2.02)%, triglyceride (TG) average (2 + 1.67)mmol/L, total cholesterol (TC) average (5 + 1.45 mmol/L); low density lipoprotein (LDL-C) average (2.8 + 0.91) mmol/L, the overall population of glycosylated hemoglobin (HbAlc) <7.0% compliance rate was 44.87%(11403), systolic blood pressure and diastolic blood pressure (SBP)<140mmHg (DBP) <80mmHg compliance rate was 40.73% (10367), low density lipoprotein (LDL-C) <2.6mmol/L compliance rate was 42.84%(10880), blood glucose, blood pressure and blood lipid were three compliance rate was 20.62% (5244). On the whole, the blood lipid level of patients with type 2 diabetes mellitus in our country is high, the LDL-C level is high, and the blood glucose, blood pressure, blood lipid compliance rate is not high (less than 50%).(2 ) with atherosclerotic cardiovascular disease (ASCVD) patients with type 2 diabetes were 6025 cases, triglyceride (TG) average (1.9 +1.51) mmol/L, total cholesterol (TC) average (4.8 + 1.66) nmol/L; low density lipoprotein (LDL-C) average (2.7 + 0.93) mmol/L, 2203 (36.56%)patients with lipid-lowering drugs, of which 2063 cases (93.65%) the use of statins; total cholesterol (TC) <4.5mmol/L compliance rate was 43.22% (2604), low density lipop,rotein (LDL-C) <2.6mmol/L (primary prevention) of the compliance rate was 47.99% (2887), low density lipoprotein (LDL-C <1.8mmol/L (two) primary prevention) of the compliance rate was 15% (904). No patients with a total of 19429 cases of group ASCVD, triglyceride (TG) average (1.9 + 1.51) mmol/L, total cholesterol (TC) average (4.8 + 1.66) mmol/L; low density lipoprotein(LDL-C) average (2.7 + 0.93) mmol/L, 3639 cases (18.73%) patients using lipid-lowering drugs in 2991 cases (82.19%) patients using statins;total cholesterol (TC) <4.5mmol/L compliance rate was 33.93% (6586),low density lipoprotein (LDL-C) <2.6mmol/L (primary prevention) of the compliance rate was 41.24% (7993), low density lipoprotein (LDL-C)<1.8mmol/L (two grade prevention) compliance rate 10.97% (2074).Patients with ASCVD had higher rates of lipid lowering drugs (statins)than those without ASCVD, and had better control of blood lipid level and higher compliance rate, and the difference was statistically significant(P<0.05). I in type 2 diabetic patients with cerebrovascular disease(ASCVD) after more use of lipid-lowering drugs, blood lipid level control is better, and no ASCVD occurred in patients with primary prevention, reduce blood lipid levels also lead to high, success rate lessly.Patients with ASCVD average blood lipid level is relatively lower,but has not yet reached; can be seen in the group of ASCVD guidelines recommend all lipid-lowering treatment of only 36.6% patients used lipid-lowering drugs, 34.2% patients chose statins. However, only 15% of the patients met the guideline recommended LDL control target(LDL< 1.8mmol/L).(3) The use of statins in patients with type 2 diabetes, a total of 5054 people (19.86%), no cardiovascular disease of cardiovascular LDL-C<2.6mmol/L primary prevention compliance rate was 41.92%(2113), associated with cardiovascular disease in patients with cardiovascular prevention LDL-C<1.8mmol/L two compliance rate was 14.68% (742); without statins group 20400 people (80.14%), no cardiovascular disease of cardiovascular LDL-C<2.6mmol/L primary prevention compliance rate was 43.06% (8767), associated with cardiovascular disease in patients with cardiovascular prevention LDL-C<1.8mmol/L two compliance rate was 10.96% (2236). There were only two levels of prevention LDL-C<1.8mmol/L compliance rate between the two groups was statistically significant (P<0.05), the primary prevention of LDL-C<2.6mmol/L compliance rate between the two groups was not statistically significant (P=0.14>0.05).(4 ) The classification of cardiovascular disease risk factors as independent variables, the blood pressure (SBP<140mmHg and DBP<80mmHg), blood glucose (HbAlC<7.0%), blood lipids(LDL-C<2.6mmol/L) were ordered Logestic regression analysis. After adjusting for confounding factors such as age, sex, body mass index(BMI), smoking, drinking, exercise, and course of disease, the results showed that:① Blood glucose compliance rate: simple type 2 diabetes patients is lower than the patients with cardiovascular disease.② The compliance rate of blood pressure: low risk group and simple type 2 diabetes group were higher than those of cardiovascular disease group.③ TC compliance rate: other risk groups were lower than the cardiovascular disease group on TC compliance rate.④ LDL compliance rate: only the diabetic group and the middle risk group compliance rate of LDL-C lower than the cardiovascular disease group.⑤ Blood glucose, blood pressure, blood lipids were all three compliance rate: only the diabetic group, and the middle risk group were lower than the cardiovascular disease group in three compliance.Conclusion(1) The control rate of blood glucose, blood pressure and blood lipid in adult patients with type 2 diabetes in China is low.(2) In our country, adult patients with type 2 diabetes have low rate of lipid-lowering drugs. Statins are the main lipid-lowering agents.(3 ) The use of statins in primary and secondary prevention of cardiovascular disease in adults with type 2 diabetes mellitus in China is low, and there is a lack of intensity of use in patients with type 2 diabetes.(4 ) Medical staff in China Lack of awareness of prevention of cardiovascular disease in patients with type 2 diabetes. |
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