Abstract：Objective To explore the effects of family history, obesity and diabetes self-management behavior (DSMB) on hemoglobin A1c (HbA1c) control and achievement among patients with type 2 diabetes mellitus (T2D) in Chinese primary medical institutions. Methods A cross-sectional analysis was conducted in T2D outpatients or inpatients successively treated in 5 diabetes specialized chain hospitals from January 2016 to December 2019, and their information was stored in the diabetes shared-care information system. HbA1c achievement (HbA1c < 7.0%) or not and the general status were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors related to HbA1c non-achievement. Results A total of 8,506 patients were enrolled in this study, with 27.75% of patients achieving HbA1c targets. There were 2,860 (33.62%) cases with positive family history and 1,541 (18.12%) cases with obesity. As for HbA1c achievement or not, statistically significant differences were found between the two groups in terms of age, diabetes duration, body mass index,smoking, education background, dietary adherence, physical exercise, adherence to blood glucose monitoring, medication compliance and therapeutic regimen (all P<0.05). Multivariate logistic regression analysis showed that obesity (OR=1.226, 95%CI:1.042-1.441) and long duration (OR=1.019, 95%CI:1.009-1.028) increased the risk of HbA1c non-achievement, while oral therapy alone (OR=0.388, 95%CI:0.345-0.436), medication compliance (OR=0.805, 95%CI:0.699-0.928) and regular exercise (OR=0.886, 95%CI:0.786-1.000) decreased the risk of HbA1c non-achievement. Conclusion This study suggests that the achievement rate of HbA1c in T2D patients in Chinese primary medical institutions is low. Therapeutic regimen, medication compliance, regular exercise and obesity are factors related to HbA1c achievement. In clinical practice, special attention should be paid to patients treated with insulin or with obesity, and patients' compliance in medication and regular exercise.
安凌王, 王丹丹, 邢海洋, 陈林慧, 汤虹, 李伟婷, 陆菊明. 家族史、肥胖及自我管理行为在2型糖尿病患者糖化血红蛋白达标中的作用[J]. 实用预防医学, 2021, 28(10): 1169-1173.
AN Ling-wang, WANG Dan-dan, XING Hai-yang, CHEN Lin-hui, TANG Hong, LI Wei-ting, LU Ju-ming. Effects of family history, obesity and self-management behavior on hemoglobin A1c achievement in patients with type 2 diabetes mellitus. , 2021, 28(10): 1169-1173.
[1] Cederberg H, Stancáková A, Kuusisto J, et al. Family history of type 2 diabetes increases the risk of both obesity and its complications: is type 2 diabetes a disease of inappropriate lipid storage?[J]. J Intern Med, 2015, 277(5):540-551. [2] Dorman JS, Valdez R, Liu T, et al. Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention[J]. Diabetes Res Clin Pract, 2012, 96(2):156-162. [3] Abbasi A, Corpeleijn E, van der Schouw YT, et al. Maternal and paternal transmission of type 2 diabetes: influence of diet, lifestyle and adiposity[J]. J Intern Med, 2011, 270(4):388-396. [4] 孙中明, 潘恩春, 缪丹丹, 等. 淮安市2 型糖尿病患者血糖控制情况与糖尿病家族史的关系[J]. 中华内分泌代谢杂志, 2017, 33(7):578-580. [5] Lee YH, Shin MH, Nam HS, et al. Effect of family history of diabetes on hemoglobin A1c levels among individuals with and without diabetes: the Dong-gu Study[J]. Yonsei Med J, 2018, 59(1):92-100. [6] Tam CL, Bonn G, Yeoh SH, et al. Investigating diet and physical activity in Malaysia: education and family history of diabetes relate to lower levels of physical activity[J]. Front Psychol, 2014, 5: 1328. [7] Choi J, Choi JY, Lee SA, et al. Association between family history of diabetes and clusters of adherence to healthy behaviors: cross-sectional results from the Health Examinees-Gem (HEXA-G) Study[J]. BMJ Open, 2019, 9(6):e025477. [8] Eliraqi GM, Vistisen D, Lauritzen T, et al. Intensive multifactorial treatment modifies the effect of family history of diabetes on glycaemic control in people with type 2 diabetes: a post hoc analysis of the ADDITION-Denmark randomized controlled trial[J]. Diabet Med, 2015, 32(8):1085-1089. [9] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志, 2018, 10(1):4-67. [10] 何权瀛, 高莹慧. 关于吸烟问题若干名词定义[J]. 中华结核呼吸杂志, 2009, 32(1):26. [11] Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance-United States 2003[J]. MMWR Surveill Summ, 2004, 53(2):1-96. [12] 陈钰仪, 彭妙官. 中文版糖尿病自护行为量表的信度和效度研究[J]. 中国实用护理杂志, 2011, 27(14):60-62. [13] 顾亦斌, 薛雨星, 盛红艳, 等. 2013年常熟市2型糖尿病患者的血糖、血脂及血压控制情况及影响因素分析[J]. 实用预防医学, 2019, 26(7):836-840. [14] Ji L, Hu D, Pan C, et al. CCMR-3B STUDY Investigators. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients[J]. Am J Med, 2013, 126(10):11-22. [15] Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT):an open-label, cluster-randomised trial[J]. Lancet, 2018, 391(10120):541-551. [16] Berkowitz RI, Marcus MD, Anderson BJ, et al. TODAY Study Group. Adherence to a lifestyle program for youth with type 2 diabetes and its association with treatment outcome in the TODAY clinical trial[J]. Pediatr Diabetes, 2018, 19(2):191-198. [17] Balducci S, D'Errico V, Haxhi J, et al. Effect of a behavioral intervention strategy for adoption and maintenance of a physically active lifestyle: the Italian diabetes and exercise study 2 (IDES_2): a randomized controlled trial[J]. Diabetes Care, 2017, 40(11):1444-1452. [18] Fayehun AF, Olowookere OO, Ogunbode AM, et al. Walking prescription of 10,000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice[J]. Br J Gen Pract, 2018, 68(667):e139-e145. [19] Giorgino F, Penfornis A, Pechtner V, et al. Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement[J]. Patient Prefer Adherence. 2018, 12:707-719. [20] Salinero-Fort MA, Carrillo-de Santa Pau E, Arrieta-Blanco FJ, et al. Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus[J]. BMC Public Health, 2011, 11:267. [21] Rathmann W, Schwandt A, Hermann JM, et al. Distinct trajectories of HbA 1c in newly diagnosed type 2 diabetes from the DPV registry using a longitudinal group-based modelling approach[J]. Diabet Med, 2019, 36(11):1468-1477. [22] Luo M, Tan CS, Lim WY, et al. Association of diabetes treatment with long-term glycemic patterns in patients with type 2 diabetes mellitus: a prospective cohort study[J]. Diabetes Metab Res Rev, 2019, 35(4):e3122. [23] Ray KK, Kendall DM, Zhao Z, et al. A multinational observational study assessing insulin use: understanding the determinants associated with progression of therapy[J]. Diabetes Obes Metab, 2019, 21(5):1101-1110. [24] Gu Y, Hou X, Zhang L, et al. The impact of initiating biphasic human insulin 30 therapy in type 2 diabetes patients after failure of oral antidiabetes drugs[J]. Diabetes Technol Ther, 2012, 14(3):244-250. [25] Weinstock RS, Braffett BH, McGuigan P, et al. TODAY study group. Self-monitoring of blood glucose in youth-onset type 2 diabetes: results from the TODAY study[J]. Diabetes Care, 2019, 42(5):903-909. [26] 中华医学会糖尿病学分会. 中国血糖监测临床应用指南(2015年版)[J]. 中华糖尿病杂志, 2015, 7(10):603-613.
2021, Vol. 28 
