关键词: 糖尿病, 2型；高血压；糖尿病并发症；疾病管理；慢性病；北京市

Abstract: Background　Type 2 diabetes mellitus（T2DM） has become an important public health problem that seriously affect the physical and mental health of Chinese people.The ultimate goal of T2DM management is to reduce the chronic complications to improve the quality of life and prolong the life-time of patients.Community health centers are the main battlefield for preventing and treating T2DM and its complications.At present，there is no report on the effectiveness of 10-year community-based management of T2DM in China.Zuojiazhuang Community is one of the communities initially participating in the Beijing Community Diabetes Research（BCDS） project.This article is a branch study on the incidence of chronic complications in T2DM patients following 10-year standardized management in the community.Objective　To investigate the incidence of chronic complications in T2DM patients with and without hypertension （HTN） after 10 years' standardized management.Methods　246 patients with T2DM from Zuojiazhuang Community were enrolled from August to December 2008.Among them，those with HTN and without were assigned to T2DM+HTN group，and T2DM group，respectively.Both groups received the unified standardized management required by the BCDS project，including regular follow-up，and referral services.Moreover，they also received review services，which were performed once a year，including physical examination〔BMI，neck circumference，waist circumference，systolic blood pressure（SBP），diastolic blood pressure（DBP）〕，biochemical indicators〔fasting blood glucose（FBG），2-hour postprandial glucose （2 h PG），glycosylated hemoglobin （HbA1c），triglyceride（TG），total cholesterol（TC），high-density lipoprotein（HDL） and low-density lipoprotein（LDL） 〕，ALT，blood urea nitrogen，serum creatinine，serum uric acid，and urinary albumin excretion rate （UAER）．All of them were followed up from the enrollment to December 2018.And review results before and after follow-up period were collected.Endpoint events include cardiovascular events，cerebrovascular events，nephropathy，retinopathy and compound endpoint events.Results　After excluding 26 cases（10.6%） who were lost to follow up，220 cases with complete data，including 47 in T2DM group and 173 in T2DM + HTN group，were finally included.At baseline，the levels of waist circumference，SBP，DBP，and TC in T2DM + HTN group were significant higher than those in T2DM group（P<0.05）．At the end of follow-up，the level of 2 h PG in T2DM + HTN group was significant higher than that of T2DM group（P<0.05）．During the period of management，the blood pressure fluctuated slightly in T2DM group，but in T2DM + HTN group，it decreased significantly from 2008 to 2011，and then fluctuated slightly.There were no significant differences in the incidence rates of end-point events between the two groups（P>0.05），including cardiovascular events，cerebrovascular events，nephropathy and retinopathy.But the incidence rate of compound endpoint events in T2DM + HTN group was significant higher than that of T2DM group（P<0.05）．There was a significant difference in the survival curve between the two groups （χ2=4.274，P=0.038）．Cox regression analysis showed that hypertension had no effect on cardiovascular events，cerebrovascular events，nephropathy and retinopathy （P>0.05），but had effect on compound endpoint events（P<0.05）．Conclusion　After 10 years' standardized management，compared with the simple T2DM，the incidence rate of the compound endpoint events significantly increased in T2DM with hypertension.Therefore，more attention should be paid to the intervention for T2DM patients with hypertension.Early detection of complications and timely intervention can reduce the mortality and improve the quality of life.

Key words: Diabetes mellitus, type 2；Hypertension；Diabetes complications；Disease management；Chronic disease；Beijing