Diabetic Control at a Family Medicine Clinic in Taiwan

某一醫學中心家庭醫學門診糖尿病控制現況

徐薇婷(Wei-Ting Hsu) ； 李龍騰(Long-Teng Lee) ； 劉文俊(Wen-Jing Liu)

《臺灣家庭醫學研究》 3卷2期&3 (2005/04) Pp. 77-87

https://doi.org/10.29475/TFMR.200504.0003

摘要

這個研究主要想了解非新陳代謝科專家對糖尿病患者的照顧狀況。利用回溯性研究，納入某醫學中心家庭醫學部糖尿病病患從2003年元月至2003年三月有就醫紀錄者。利用國際疾病代碼(ICD)搜尋，總共找到2,042位病患診斷爲糖尿病，再以系統抽樣法每四位抽取一位，約選取508名病患，最後經由訪問及病歷回顧收集資料，約398位個案進入本研究。病人的平均年齡是63歲，男女比例差不多，發病時間平均爲8年，身體質量指數26kg/平方公尺，平均糖化血色數7.6±1.6%，平均飯前血糖是163.9±58.9mg/dL，平均血壓133/78mmHg，三酸甘油酯185mg/dL及膽固醇203mg/dL。92.2%的病患的血糖控制是只單獨使用口服降血糖藥物，並用口服降血糖藥物與胰島素者約爲1.8%, 4.4%使用胰島素，15%利用飲食控制。23.1%的病人有自我監測糖尿病控制狀況其中一位使用尿液監測，其餘爲監測血糖，監測次數平均爲每個月8.2次。26.3%的病例記錄有神經病變，55.8%有檢測蛋白尿，36.1%有眼底記錄，70.9%有高血壓，66%有高血脂，及21.6%有心臟冠狀動脈疾病，11.2%罹患中風。總結，我們的研究發現糖尿病病患在醫學中心的家庭醫師的照顧之下仍有進步的空間，以HbAlc結果來看並不遜於內分泌專科醫師的照顧結果，但是糖尿病的併發症篩檢比例較低，需要更進一步瞭解與改進。

並列摘要

The aim of this study was to provide an overview of diabetic care status by non-endocrinologists in Taiwan. A retrospective study was carried out in Taiwan, involving randomly selected patients diagnosed with non-insulin dependent diabetes mellitus who attended outpatient clinic of the Department of Family Medicine at National Taiwan University Hospital over a 3-month period between January 2003 and March 2003. A total of 2,042 patients diagnosed as diabetes mellitus were collected via ICD code number, of which 508 were selected via systematic sampling, and 385 patients were finally recruited into this study by interview and medical records review. The overall mean age of the 385 patients was 63 years old and the percentage of male to female ratio was about equal. The average duration of disease was 8 years and their average BMI was 26 kg/m^2, 40.9% of patients had BMI ＜25 kg/m^2, their mean HbA1c of 7.6±1.6%, mean FBG level 163.9±58.9 mg/dL with majority (62.7%) FBG ＞140 mg/dL, mean blood pressure of 133/78 mmHg, triglyceride level of 185 mg/dL and cholesterol level of 203 mg/dL. The majority of the patients (92.2%) were treated with oral hypoglycemic agents (OHAs) alone or in combination with insulin (1.8%). Among the remaining 6%, 4.4% of patients were treated solely with insulin therapy; and 1.5% used dietary control exclusively. 75.5% was given sulphonylurea, 68% used biguanide, 21.9% was treated with insulin sensitizer (excluding biguanide). 63.7% of patients were using 2 or more kinds of OHAs concurrently. 23.1% of patients self-monitored their sugar level. Of which, one patient did urine glucose monitoring only. The frequency of self-monitoring was 8.2 times per month. 26.3% had records pertaining to neuropathy, 55.8% checked for proteinuria, 36.1% of patients had eyeground data. According to the patient chart records, 70.9% of patients had history of hypertension, 66% had hyperlipidemia, 21.6% had coronary artery disease, and 11.2% had history of stroke. Our study concluded that by measuring HbA1c, the glycemic control in diabetic patients cared by family physicians at medical center is tantamount to those cared by the endocrine specialists, though some room still exists to perfection. However, the rate of screening for diabetic complications is low, thus more education and better awareness of the potential to delay diabetic complications must be emphasized.

並列關鍵字

diabetes mellitus ； glycemic/metabolic control ； family physician ； medical center ； diabetic care