Trial design: Our study is to investigate the feasibility and effectiveness of multiple cardiovascular factors intervention (MFI) in type 2 diabetes patients in China’s primary care setting. Methods: We performed a cluster randomized trial to compare the proportion of patients achieved the targets between usual care group (control, 9 sites, n = 868) and MFI group (8 sites, n = 739) among patients with type 2 diabetes in primary care setting. Logistic regression model with random effects was used to estimate the association of the effect of intervention and the proportion achieved the targets. Results: At baseline, the end of 1 year, and 2 years follow-up, the proportion of patients achieved all 3 target goals (HbA1c < 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol < 2.6 mmol/L) were 5.7%, 5.9%, 5.7% in the control group and 5.9%, 10.6%, 12.3% in the MFI group. After adjusting sex, age, diabetes duration, body mass index, HbA1c, blood pressure, and low-density lipoprotein cholesterol at baseline, there was no difference between the 2 groups (OR (95% CI): 1.27 (0.38–4.27) and 1.86 (0.79–4.38) for the first year and second year, respectively). When stratified by payment method, the patients with medical insurance or public expenses had a higher proportion achieved target goals (6.9% vs 16.4%, OR (95% CI): 2.30 (1.04–5.08)) in the second year. Conclusions: The controlling of cardiovascular risk factor targets remains suboptimal among patients with type 2 diabetes in primary care setting. MFI in type 2 diabetes improved cardiovascular disease risk profile, especially in the patients with medical insurance.

目的 探讨社区2型糖尿病患者颈动脉内中膜增厚的相关因素.方法 选取2013年7月至2016年12月北京市平谷区6个社区常住人口中参加北京市《糖尿病规范化管理模式研究》的535例2型糖尿病患者,根据颈动脉内中膜厚度分为正常组(282例)与增厚组(253例),比较两组患者的性别、年龄、吸烟情况、腰围、体重指数、颈动脉斑块、高血压及控制情况、眼底病变、糖尿病病程、肾小球滤过率、尿白蛋白/肌酐比值、生化指标(总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血糖、尿酸)、糖化血红蛋白水平.结果 增厚组与正常组的年龄、颈动脉斑块、眼底病变、高血压、高血压控制情况、糖尿病病程、肾小球滤过率、尿白蛋白/肌酐比值、糖化血红蛋白水平差异均有显著性(P<0.05).Logistic回归分析提示尿白蛋白/肌酐比值(OR=1.040,95％CI 1.030～1.050,P<0.001)、高血压(OR=1.663,95％CI 1.048～2.637,P=0.031)、年龄(50～60岁组:OR=2.647,95％CI 1.411～4.964,P=0.002;>60岁组:OR=7.420,95％CI 3.761～14.639,P<0.001)与颈动脉内中膜增厚的风险增加相关,而女性(OR=0.511,95％CI 0.310～0.842,P=0.008)与颈动脉内中膜增厚的风险下降相关.结论 尿白蛋白/肌酐比值、年龄、高血压、性别是2型糖尿病患者颈动脉内中膜增厚的危险因素.

Objective To explore whether changes of microalbuminuria are paralleled with the reduced glomerular filtration rate in type 2 diabetic patients. Methods A study was conducted in 1 184 type 2 diabetic patients from 27 Beijing community clinics between Apr. 2013 and Mar. 2015. Data of albumin/creatinine ratio (ACR), serum creatinine and lipid profiles were collected. Estimated glomerular filtration rate (eGFR) was evaluated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault(CG), simplified Modification of Diet in Renal Disease (MDRD) formulas, and designated as eGFREPI, eGFRCG, eGFRMDRD, respectively. All data were expressed as ±s or median (interquartile range) as appropriate. The Student's t test or Mann-Whitney test was used for between-group comparison for continuous variables, and the Chi-square test for categorical variables. Spearman Rank Correlation was used to find the correlation between ACR and eGFR. Results Of all type 2 diabetic patients aged (61±9) yrs, 754 were males (41.6%) and 1 060 were females (58.4%). ACR was not correlated with eGFREPI (r=-0.013), eGFRCG (r=-0.014) or eGFRMDRD (r=-0.007). The changes of microalbuminuria were not paralleled with the reduced glomerular filtration rate. Of patients with macroalbuminuria (defined as ACR≥300 mg/g), 83.3% (15/18) male patients and 50% (11/22) female patients had eGFREPI≥90 ml·min-1· (1.73 m2) -1. Of patients with normal albuminuria (defined as ACR<22.1 mg/g in male and ACR<30.9 mg/g in female), 21% (101/482) male patients and 30.7% (238/776) female patients had eGFREPI<90 ml·min-1· (1.73 m2) -1, and 2.5% (12/482) male patients and 3.4% (26/776) female patients had eGFREPI<60 ml·min-1· (1.73 m2) -1. Conclusion Microalbuminuria can not fully reflect the reduced glomerular filtration rate in type 2 diabetic patients. Key words: Diabetes mellitus, type 2; Microalbuminuria; Glomerular filtration rate