科研之友
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摘要
In Malaysia diabetes is a growing concern. The third National Health and Morbidity survey in 2006 showed that the rate was further increased to 14.9%. Diabetic complications are insidious in onset but may be present in up to 50% of type 2 diabetes at diagnosis.
To compare factors which were associated with the level of glycemic control and prevalence of complications among good and poor glycemic control patients with type 2 diabetes mellitus.
It was a case-control study using secondary data from medical record of HUSM that compare groups of good glycemic control with poor glycemic control patients attending Diabetes Centre, HUSM from December 2005 till December 2006. Case and controls were matched with duration of illness (less than 10 years duration). Inclusion criteria for cases. 1. All type 2 diabetes patients age more than 18 years and above 2. HbA1c >= 7.0% Exclusion criteria for case 1. Type 1 diabetic patients 2. HbA1c < 7.0% 3. Unable to trace folders 4. Incomplete or absence data.
In our study, majority of patients were more than 50 years of age. In cases, patients who were more than 50 years of age were 71 (64.5%), whereby in control group patients who were more than 50 years of age were 97 (88.2%). Maximum age for cases was 92 and minimum age was 37 where as maximum age for control was 85 years and minimum age was 37. Age of onset of diabetes was statistically significant where 42 (38.2%) of cases first diagnosed diabetes at age less than 45 years old and 68 (61.8%) diagnosed at 45 years and above where as in control group only 13 (11.8%) were diagnosed less than 45 years of age. Sex distribution in both control and cases were comparable. Majority of patients in both groups were Malays, 92 (83.6%) in cases and 89 (80.9%) in control group and not statistically significant. Patients were classified into two groups according to treatment modalities, whether they were on insulin or not. In control group only 5 (4.5%) of patients were on insulin and 105 (95.5%) of patients were on oral or diet treatment, where as 22 (20%) of patients in cases group were on insulin and 88 (80%) were on oral or diet treatment and was statistically significant with p value < 0.001. In controls, majority of patients were on 1 of oral hypoglycemic agent 64 (58.2%) where as in cases majority of them were on more than 1 type of oral hypoglycemic agent 87 (79.1%) and statistically significant with p value of < 0.001. Less than half of patients in both groups practice home blood glucose monitoring whereby 21(19.1%) in cases compare to 15 (13.6%) in controls. It was not statistically significant. Majority of patients were non obese. Most of patients in both groups have concomitant illness 103 (93.6%) in cases and 100 (90.0%) in controls with majority have more than one concomitant illnesses.
Prevalence of complications in good glycemic control and poor glycemic control group
The number of patients in cases who had diabetic complications was 62.7% (95% CI: 53.5, 71.9), where as in controls was 61.8% (95% CI: 52.6, 71.0). It showed that more than half of patients in type 2 diabetic, even if his blood sugar was well control had diabetes complications. Commonest complications in cases was nephropathy 36.4% (95% CI: 27.2, 45.5) where as in controls was neuropathy 42.7% (95% CI: 33.3, 52.1).
Glycemic status was associated with age of onset of diabetes, whereby the younger age at onset the higher chance to have poor control of diabetes. Patients on insulin, obese and used more number of oral hypoglycemic agents, the more chance of patients to be poorly control. The prevalence of complications in each group was almost comparable regardless of glycemic status.
- 出版日期2011-6
