第49届欧洲糖尿病研究协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月24日下午，在“Managing and monitoring diabetes: who does well and who doesn't?”壁报专场上，中山大学附属第三医院翁建平教授团队报告的一项研究指出，中国1型糖尿病(T1DM)患者血糖、血压和血脂的控制现况同指南目标值相比较仍存在较大差距。
T1DM要求对血糖、血压和血脂的综合管理。目前中国T1DM患者的代谢控制情况尚不明确。本研究调查了中国T1DM患者的代谢控制现况，以其提供更佳的公共卫生信息。
这项多中心、横断面研究在中国广东省21个城市开展，调查了自2000年01月01日至2012年03月31日诊断的T1DM患者。本研究使用专门的表格采集患者的临床资料，在中山大学附属第三医院中心化检测HbA1c、LDL-c、HDL-c和TG等指标。最后计算HbA1c、血压、血脂水平以及以上指标的达标率。
结果显示，总计纳入1461例T1DM患者，其中51.5%为女性。年龄为29.5岁(20.6岁～40.0岁)[中位数(四分位数间距)]，病程3.7年(1.6年～7.8年)，发病年龄为24.4岁(15.9～34.9岁)。超重/肥胖和低体重的比例分别是11.4%和23.9%。在18岁以上的成年患者中，21.0%存在腹型肥胖。HbA1c 8.7%(7.1%～11.1%)，24.7%的患者达到年龄特异性目标值;青少年组(13～19岁)的HbA1c值最高(中位数10.2%)，达标率亦最低(14.2%)。收缩压和舒张压分别为113 mm Hg(105 mm Hg～122.5 mm Hg)和71.5 mm Hg(66 mm Hg～78.5 mm Hg)。69.7%的患者血压达标，女性达标率高于男性(72.4%比67.0%，P=0.04)。LDL-c、HDL-c和TG分别为2.5 mmol/L(2.0 mmol/L～3.2 mmol/L)、1.4 mmol/L(1.1 mmol/L～1.7 mmol/L)和1.1 mmol/L(0.8 mm Hg～1.7 mm Hg)，其达标率分别为55.3%、75.5%和76.7%。血糖和血压同时达标的比例为16.2%，血糖和血脂同时达标的比例为12.7%，三项指标(血糖、血压和血脂)同时达标的比例为9.0%。
研究结论表明，中国T1DM患者的代谢控制现况同指南目标值相比较仍存在较大差距。当前迫切需要对这些患者进行代谢控制的综合管理。
| Prevalence of inadequate metabolic control: results from a provincial wide survey in 1,461 patients with type 1 diabetes in China（1型糖尿病代谢控制不达标的比例——来自中国广东省1461例T1DM患者的资料 ） |
| Background and aims: Type 1 diabetes mellitus (T1DM) requires comprehensive management of glycaemia, blood pressure and blood lipids. However, data of metabolic control status in Chinese T1DM patients is still lacking to date. In this study, we sought to investigate the current status of metabolic control in Chinese T1DM patients, aiming to provide better public health messages. Materials and methods: This multicenter, cross-sectional study investigated patients with established T1DM between January 1, 2000 and March 31, 2012 from 21 cities in Guangdong, China. Data entry forms were used to collect patients’ clinical information, and HbA1c, LDL-C, HDL-C and triglyceride (TG) were measured centrally. HbA1c, blood pressure, blood lipid levels and target levels achieving rates were calculated. Results: A total of 1,461 patients were enrolled (51.5% female). The age was 29.5 years (20.6-40.0) [median (interquartile range)], duration of T1DM was 3.7 years (1.6 -7.8), age at diagnosis was 24.4 years (15.9-34.9). Proportions of overweight/obese and underweight patients were 11.4% and 23.9%, respectively. Of patients ≥ 18 years, 21% were with abdominal obesity. HbA1c level was 8.7 % (7.1%-11.1%), and 24.7% of patients achieved the age-specific target level. Highest HbA1c level (10.2%), as well as lowest target level achieving rate (14.2%), were observed in adolescence (13-19 years). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 113 mmHg (105-122.5) and 71.5 mmHg (66-78.5), respectively. A total of 69.7% patients achieved target blood pressure level, female higher than male (72.4% vs. 67.0%, P=0.04). LDL-C,HDL-C and TG levels were 2.5 mmol/L (2.0-3.2), 1.4 mmol/L (1.1-1.7) and 1.1 mmol/L (0.8-1.7), respectively, with 55.3%, 75.5% and 76.7% patients achieving the target levels, respectively. Only 16.2% achieved the target levels of both blood sugar and blood pressure, 12.7% achieved the target levels of both blood sugar and blood lipids, and 9.0% achieved all target levels of blood sugar, blood pressure and blood lipids. Conclusion: There is a giant gap between current status and the target levels. Our data demonstrated urgent need for a more comprehensive management for these patients. |
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