社区2型糖尿病患者临床惰性现状及其影响因素分析
nalysis on the Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community
背景 虽然 2 型糖尿病（T2DM）不能被彻底治愈，但遵循指南对 T2DM 患者进行及时的社区管理可以使其血糖得到良好控制，这已成为共识。然而由于 T2DM 相关临床惰性的影响，患者血糖长期处于不达标状态。了解社区 T2DM 患者临床惰性的现状及影响因素对提高糖尿病控制效果具有重要意义，但目前相关研究较少。目的 调查社区 T2DM 患者接受健康管理过程中临床惰性的现状，并分析其影响因素。方法 2020 年 1—12 月，采用整群随机抽样法，选取江苏省淮安市清江浦区和淮安区参与国家基本公共卫生服务项目的社区 T2DM 患者为研究对象，对其进行“面对面”的问卷调查、体格检查及实验室检查。将 HbA1c 控制未达标（HbA1c ≥ 7.0%）的 T2DM 患者过去 3个月未升级治疗定义为存在临床惰性。采用多因素逐步 Logistic 回归分析社区 T2DM 患者临床惰性检出情况的影响因素。结果 共纳入 3 346 名 HbA1c 未达标的社区 T2DM 患者，社区 T2DM 患者临床惰性总体检出率为 93.96%（3 144/3 346），其中男性检出率为 94.84%（1 139/1 201），女性检出率为 93.47%（2 005/2 145）。不同饮食控制情况、体育锻炼情况、血糖监测周期、糖尿病并发症发生情况，以及血脂异常（史）、冠心病史、脑卒中史、肿瘤病史情况的社区 T2DM 患者临床惰性检出率比较，差异有统计学意义（P<0.05）。多因素逐步 Logistic 回归分析结果显示，控制饮食〔OR（95%CI）=0.585（0.382，0.894）〕、血糖监测周期≤ 1 周〔OR（95%CI）=0.470（0.344，0.644）〕、有糖尿病并发症〔OR（95%CI）=0.606（0.423，0.868）〕、有血脂异常〔OR（95%CI）=0.725（0.532，0.988）〕、有冠心病史〔OR（95%CI）=0.659（0.458，0.949）〕及脑卒中史〔OR（95%CI）=0.699（0.511，0.955）〕的社区 T2DM患者出现临床惰性的可能性更小（P<0.05）。结论 社区 T2DM 患者接受健康管理过程中存在严重的临床惰性问题，临床惰性的出现情况与其饮食控制情况、血糖监测周期、糖尿病并发症发生情况及合并疾病（史）情况有关联。
BackgroundAlthough type 2 diabetes mellitusT2DMcannot be completely curedhoweverthere is a consensus that timely community management of T2DM patients following guidelines can lead to good glycemic control. Howeverblood glucose of the patients is chronically suboptimal due to T2DM-related clinical inertia. It is crucial for improving the effectiveness of diabetes control to determine the current status and influencing factors of clinical inertia in T2DM patients in communitybut there is limited literature on this topic. ObjectiveTo investigate current status and influencing factors of clinicalinertia during health management in T2DM patients in community. MethodsFrom January to December 2020T2DM patients receiving health management services from the National Basic Public Health Services in Qingjiangpu and Huai'an districtsHuaian CityJiangsu Provincewere recruited using cluster random sampling method to perform face-to-face questionnaire surveyphysical examinationand laboratory tests. Clinical inertia was defined as the absence of intensification in antidiabetic treatment for patients with inadequate HbA1c controlHbA1c ≥ 7%in the past three months. Stepwise multiple Logistic regression analysis was performed to identify influencing factors of the detection of clinical inertia in T2DM patients in community. ResultsA total of 3 346 T2DM patients with inadequate glycemic controlHbA1c ≥ 7%were included in the studywith the overall detection rate of clinical inertia in T2DM patients of 93.96%3 144/3 34694.84%1 139/1 201in men and 93.47%2 005/2 145in womenrespectively. There were significant differences in the detection rate of clinical inertia among T2DM patients with different levels of dietary controlphysical activityblood glucose monitoring periodsdiabetic complicationsdyslipidemiahistoryand history of coronary heart diseasestrokeand cancer. Stepwise multiple Logistic regression analysis showed that dietary controlOR95%CI=0.5850.3820.894glucose monitoring period ≤ 1 weekOR95%CI=0.4700.3440.644presence of diabetic complicationsOR95%CI=0.6060.4230.868dyslipidemiaOR95%CI=0.7250.5320.988history of coronary artery diseaseOR95%CI=0.6590.4580.949and strokeOR95%CI=0.6990.5110.955were associated with a lower prevalence of clinical inertia in T2DM patientsP<0.05. ConclusionThere is a serious problem of clinical inertia in T2DM patients undergoing health management in communitythe prevalence of clinical inertia is closely related to patients' dietary controlglucose monitoring periodpresence of diabetic complicationsand comorbid diseaseshistory.
武鸣、李殿江、沈冲、孙中明、王苗苗、文进博、潘恩春
10.12114/j.issn.1007-9572.2023.0178
内科学临床医学医学研究方法
糖尿病，2 型临床惰性强化治疗健康管理国家基本公共卫生服务项目社区卫生服务影响因素分析
iabetes mellitus，type 2linical inertiareatment intensificationHealth managementNational essential public health services programsommunity health servicesRoot cause analysis
武鸣,李殿江,沈冲,孙中明,王苗苗,文进博,潘恩春.社区2型糖尿病患者临床惰性现状及其影响因素分析[EB/OL].(2023-07-24)[2025-08-02].https://chinaxiv.org/abs/202307.00274.点此复制
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