Abstract: Background  For diabetic patients，community-based management is comparatively good，because by which glycemic and other essential indicators can be regularly monitored，real-time follow-up services can be obtained，and the management is easy to access owing to short spatial distance. However，how to deliver standardized community-based management for such patients is need to be cleared further. Objective  To investigate the use of small-dose Aspirin for primary and secondary prevention of cardio-cerebrovascular diseases in community-dwelling type 2 diabetic patients. Methods  We conducted this survey in December 2017 in a stratified and random sample of 490 type 2 diabetic patients who were under the management of 5 general practitioner teams from Shanghai Hudong Community Health Center. The survey contents consisted of 3 parts，namely，personal data（basic information，past history of ASCCVD，family history of ASCCVD，smoking history，and Aspirin use），anthropometric data（weight and blood pressure） and laboratory data（routine blood parameters，liver and kidney function parameters，and glycemic and lipid parameters），collected with a self-developed interview-based questionnaire，physical examination，fasting venous blood testing，respectively. Indications for using Aspirin for primary or secondary prevention of cardio-cerebrovascular diseases were assessed by the risk of developing ASCCVD，and the use status was evaluated. Reasons for those should use Aspirin but did not use were analyzed. Risk of Aspirin-related bleeding in the elderly was assessed. Results  The study finally enrolled 465 cases，including 225（48.4%） males and 240（51.6%） females. Of them，219（47.1%） had indications for use of Aspirin for primary prevention of cardio-cerebrovascular diseases，with a rate of Aspirin use of 19.6%（43/219），208（44.7%） had indications for use of Aspirin for secondary prevention，showing a rate of Aspirin use of 49.5%（103/208），and other 38（8.2%） had no indications. Patients who had indications but did not use Aspirin were mostly due to knowing little about this or receiving no related information from the doctor〔62.3%（175/281）〕．The rate of using Aspirin for the prevention of cardio-cerebrovascular diseases in those aged ≥80 years was 50.0%（15/30），and 26.7%（4/15） of them were at high risk of Aspirin-related bleeding，13.3%（2/15） were found with extremely high risk predicted by the CRUSADE score.Conclusion  Inadequate use of Aspirin for prevention of diabetes in community，especially primary prevention.For type 2 diabetic patients under community-based management，before using Aspirin for primary or secondary prevention of cardio-cerebrovascular diseases，individualized risk-benefit assessment of Aspirin use should be performed by GPs. Additionally，dynamic follow-ups should be delivered to the patients during Aspirin administration period.

Key words: Diabete mellitus, type 2；Aspirin；Community health services；Primary prevention；Secondary prevention

摘要： 背景  糖尿病有着定期监测、实时随访、地域便利等社区管控的优势，社区规范管理现况有待进一步明确。目的  了解并分析社区2型糖尿病患者阿司匹林一、二级预防使用现况。方法  按照分层随机抽样原则，选取2017年12月上海市沪东社区卫生服务中心下设5个全科团队管控的2型糖尿病患者490例为调查对象。调查内容由问卷（基本信息、既往史、家族史、吸烟史、阿司匹林服用情况）、体检（体质量、血压）、实验室数据（血常规、肝肾功能、血糖、血脂）组成。依据冠状动脉粥样硬化性脑心血管疾病风险进行评定，了解阿司匹林一、二级预防在糖尿病患者中的使用现况，同时调查有预防指征而未用药的原因，以及预测高龄糖尿病患者阿司匹林预防使用的出血风险。结果  最终纳入465例，其中男225例（48.4%），女240例（51.6%）。有阿司匹林一级预防指征者219例（47.1%），有阿司匹林二级预防指征者208例（44.7%），无阿司匹林预防指征者38例（8.2%）。有一级预防指征的糖尿病患者阿司匹林使用率为19.6%（43/219），有二级预防指征的糖尿病患者阿司匹林使用率为49.5%（103/208）。有阿司匹林预防指征但未用药原因中不知晓或医生未提及占比最大，为62.3%（175/281）。≥80岁年龄段的糖尿病患者使用阿司匹林预防者占50.0%（15/30），对其行抗血小板及抗凝治疗（CRUSADE）出血风险预测发现，出血风险高危者占26.7%（4/15），极高危者占13.3%（2/15）。结论  社区糖尿病患者阿司匹林预防的使用率不足，特别是一级预防。对社区卫生服务中心管控的糖尿病患者，行阿司匹林脑心血管疾病一、二级预防，需要全科医生个体化评估其风险、获益，并进行动态规律随访。

关键词: 糖尿病, 2型；阿司匹林；社区卫生服务；一级预防；二级预防