Abstract: Objective　To compare the health-related quality of life and health service utilization between patients with diabetes alone and those with comorbid diabetes mellitus.Methods　The data were derived from part of the national survey of health service utilization among residents in 2016.A sample of 517 diabetic patients in 4 provinces of China were enrolled.Their prevalence of chronic comorbidities，demographic characteristics，health-related quality of life，diabetes attack during the survey period and healthcare seeking behavior were analyzed.Results　Among the 517 cases，139（26.9%） had diabetes only，while other 378（73.1%） had comorbid diabetes mellitus.These two groups had significant differences in distribution of age，employment status，and commercial health insurance status（P<0.05）．Compared with those with diabetes only，comorbid diabetes mellitus patients were more likely to suffer from problems associated with mobility，self-care，usual activities，pain/discomfort，anxiety/depression（P<0.05），and they scored much lower in terms of self-rated general health status on the survey day（P<0.05）．Of the 475 with diabetes attack during the survey period，149（31.4%） were found with self-medication behavior or continued the treatment prescribed previously（43 with diabetes，106 with comorbid diabetes mellitus），326（68.6%） sought outpatient treatment（85 with diabetes，241 with comorbid diabetes mellitus）．The type of visited medical institutions differed significantly between diabetic patients and comorbid diabetes mellitus patients seeking outpatient treatment（P<0.05），while the number of visits and services did not（P>0.05）．Conclusion　Comorbid diabetes mellitus patients had poorer health-related quality of life compared with those with diabetes alone.Among those who did not seek outpatient treatment，patients with diabetes alone were more likely to carry out self-medication compared with comorbid diabetes mellitus patients.Of those seeking outpatient treatment，patients with diabetes alone preferred grassroots institutions instead of comorbid diabetes mellitus patients.

Key words: Diabetes mellitus, Comorbidity, Quality of life, Health services, Comparative study

摘要： 目的　比较单纯糖尿病患者与糖尿病共病患者的健康相关生命质量和卫生服务利用情况。方法　本研究资料来源于2016年居民卫生服务利用行为监测中4个省份糖尿病患者的调查数据，共有517例糖尿病患者，记录其慢性病患病情况、人口学特征、健康相关生命质量、调查期间糖尿病发病情况、就医行为。结果　517例糖尿病患者中，单纯糖尿病139例（26.9%），糖尿病共病378例（73.1%）。单纯糖尿病患者与糖尿病共病患者年龄、就业状况、商业医疗保险情况比较，差异有统计学意义（P<0.05）。糖尿病共病患者行动、自我照顾、平常活动、疼痛或不舒服、焦虑或抑郁无问题率小于单纯糖尿病患者，调查当日自身健康总体情况自评得分低于单纯糖尿病患者（P<0.05）。517例糖尿病患者中，有475例在调查期间发病，其中选择自我医疗或遵原医嘱持续治疗149例（31.4%，其中单纯糖尿病43例，糖尿病共病106例），选择门诊就诊326例（68.6%，其中单纯糖尿病85例，糖尿病共病241例）。门诊就诊患者中，单纯糖尿病患者就诊次数、就诊接受的服务与糖尿病共病患者比较，差异无统计学意义（P>0.05）；门诊就诊患者中，单纯糖尿病患者就诊机构类别与糖尿病共病患者比较，差异有统计学意义（P<0.05）。结论　相比单纯糖尿病患者，糖尿病共病患者的健康相关生命质量更低；未于门诊就诊患者中，相比糖尿病共病患者，单纯糖尿病患者更加倾向于选择自我医疗治疗疾病；门诊就诊患者中，相比糖尿病共病患者，单纯糖尿病患者更加倾向于去基层医疗机构就诊。

关键词: 糖尿病, 共病现象, 生活质量, 卫生服务, 对比研究