利用糖化血色素及微白蛋白來評估中部地區糖尿病病人的控制成效; Population based survey HbA1c and microalbumin of Diabetes patients control in central Taiwan

中國醫藥大學機構典藏 China Medical University Repository, Taiwan > 醫學院 > 醫學檢驗生物技術學系暨碩士班 > 博碩士論文 > Item 310903500/876

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题名:	利用糖化血色素及微白蛋白來評估中部地區糖尿病病人的控制成效;Population based survey HbA1c and microalbumin of Diabetes patients control in central Taiwan
作者:	蕭瓊子;Chiung-Tzu Hsiao
贡献者:	中國醫藥大學：醫學檢驗生物技術學系碩士班
关键词:	糖化血色素;微白蛋白;HbA1c;microalbumin
日期:	2007-06-08
上传时间:	2009-08-12 17:09:55 (UTC+8)
摘要:	許多的研究顯示，嚴格的監控糖尿病病人的血糖可以降低糖尿病併發症的風險。糖化血色素及尿中微白蛋白是二項血糖監控很好指標，本研究的目的主要是為了瞭解中部地區糖尿病病人其血糖的控制成效。我們總共收集了53個一般醫療照護單位（及基層衛生所），包含台中縣31個及彰化縣22個衛生所及其所支援衛教之診所，共有2293個病人的血液及尿液的檢體。糖化血色素的檢測是使用高壓液相層析法 (HPLC；ion-exchange high performance liquid chromatography)且經過美國國際糖化血色素標準化協會(NGSP；National Glycohemoglobin Standardization Program)驗證過的方法來測定，而尿中微白蛋白則使用免疫散射法(Nephelometry)。針對2293個病人所檢測的結果，糖化血色素平均為8.0 ± 1.6%，大於8.0 % 以上的高達43.1%，顯示未達到很好的照護指標，僅有32.7%的糖化血色素結果小於目標值7.0 %。我們也進一步比較這53個一般醫療照護單位，發現有22個醫療照護單位轄區的糖尿病病人，有18.8% 的患者血糖的監控結果非常不理想，其糖化血色素結果大於9.5%。在尿液檢體方面則有34%的病人出現蛋白尿，其中有26%為微白蛋白尿，亦即ACR值介於30-300 μg/mg之間。為了要預防慢性糖尿病併發症的發生，嚴格的監控血糖是非常重要的。我們的調查模式建立了以糖尿病族群為基準來了解其血糖控制的成效，此次的研究結果顯示，目前糖尿病病人的照護成效仍無法令人滿意。所以要提高病人的血糖監控成效，糖尿病照護教育的介入是非常重要的。 Many studies have shown that improved glycemic control reduces the risk of many diabetes mellitus (DM) complications. HbA1c and microalbuminuria are two good indicators of glycemic control. The purpose of this study was to understand a population based on status of diabetes control in central Taiwan. A total of 2,293 blood and urine samples of DM. patients were collected from 53 general medical care units (22 in Changhua and 31 in Taichung). The national glycohemoglobin standardization program (NGSP) calibrated ion-exchange high performance liquid chromatography (HPLC) method was used for the measurement of HbA1c. Nephelometry method was used for urine microalbumin determination. The mean value of HbA1c was 8.0±1.6% in 2,293 patients and the majority (43.1%) had HbA1c values exceeding 8.0%, indicating of poor glycemic control. Only 32.7% had HbA1c value within glycemic control target (below 7.0%). 18.8% had HbA1c values from the 53 general medical care units were also compared. It revealed that 22 medical care units had poor performance for their DM patients, because they had more than 18.8% of their patients having HbA1c values exceeding 9.5%. 34% of the total specimens had proteinuria. Among them 26% were still in the stage of microalbuminuria (ACR value between 30-300μg/mg creatinine). To prevent chronic diabetic complications, more strenuous glycemic control was required. Our investigation model established the population based status of glycemic control in DM patients. The results revealed that the glycemic control was still unsatisfactory in our study. An intervention of DM care education was needed for the improvement of glycemic control.
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