Abstract: Background　Glycemic control in diabetics is improving with the development of antidiabetic drugs and evidence-based medicine. As diabetes is a chronic disease requiring long-term and even lifetime drug treatment，ensuring medication safety has become a focus of the whole society，especially the majority of elderly diabetic patients and medical workers. Objective　To analyze the use of antidiabetic drugs in a diabetes population with relevant management from a district of Shanghai，to provide a reference for clinical rational drug use and diabetes management. Methods　Data of type 2 diabetics were collected from Shanghai's Songjiang District Health Management Platform，involving 31 199 cases registered from October 2016 to September 2017，including the number of antidiabetic drugs，DDDs，drug utilization index，HbA1c and glycemic monitoring method. Results　Among 31 199 diabetic patients，20 152（64.59%） used antidiabetic drugs. These antidiabetic drugs involved 7 kinds and 22 forms of hypoglycemic drugs，among which those with the greatest DDDs were biguanides，two sulfonylureas （including glimepiride and gliclazide），and two forms of insulin（ubilin and novoline） and one α-glucosidase inhibitor（acarbose）. Age-based analysis revealed that the utilization rate of antidiabetic drugs increased with age，so did the rate of combined use of antidiabetic drugs（P<0.05）. The rate of only using insulin injection decreased with age（P<0.05）. The rate of using both oral antidiabetic drugs and insulin injection increased with age （P<0.05）. The average dispensing times，total medication days，kinds of antidiabetic drugs，dosage of insulin and dosage of chemically synthesized oral antidiabetic drugs varied significantly across different age groups（P<0.05）. Glycemic monitoring was implemented in 61.33%（12 360/20 152） of the participants，with an annual monitoring frequency of 3 times per person. The distribution of glycemic monitoring methods varied significantly across different age groups（P<0.05）. The overall rate of meeting ideal and good target levels of HbA1c was lower in those using insulin injection than that of those using oral antidiabetic drugs（P<0.05）. Conclusion　In this community health center，the kinds of antidiabetic drugs are basically complete and their use is relatively reasonable. The first-choice drug is biguanides，followed by sulfonylureas. Most therapies consist of biguanides or sulfonylureas，used either alone or in combination.However，the use of insulin is extremely unreasonable，indicating that insulin therapy fails to exert its proper effect in the community. In addition，the rates of using antidiabetic drugs，good medication adherence and continuous glycemic monitoring in the diabetes group are low.

摘要： 背景　随着降血糖药不断研发及循证医学的快速发展，糖尿病患者的血糖控制情况不断改善。但糖尿病是慢性疾病，需长期甚至终生坚持药物治疗，保障药物的安全使用已成为全社会、特别是广大老年糖尿病患者与医务人员关注的焦点。目的　分析上海市松江区糖尿病管理人群降血糖药使用情况，为临床合理用药、糖尿病管理提供参考。方法　选择2016年10月—2017年9月纳入上海市松江区健康管理平台的31 199例2型糖尿病患者为研究对象。收集糖尿病患者药物使用的数量、用药频度（DDDs）、药物利用指数（DUI）、糖化血红蛋白（HbA1c）情况及血糖监测方式。结果　31 199例糖尿病患者中，20 152例（64.59%）使用降血糖药。糖尿病患者使用的降血糖药共涉及7类22个品种，DDDs排名较前的分别为：双胍类；磺酰脲类中的格列苯脲、格列分散片；胰岛素类主要为优泌林与诺和灵及α-葡萄糖苷酶抑制剂的阿卡波糖。按年龄进行分组后，趋势χ2检验结果显示，糖尿病患者糖尿病药物使用率随着年龄的增长呈升高趋势；联合使用药物情况随年龄增长而增加；单纯注射胰岛素的糖尿病患者比例随着年龄的增长而下降，口服降糖药且注射胰岛素的患者占比随着年龄增长而升高（P<0.05）。不同年龄糖尿病患者平均配药次数、共计用药天数、平均用药种类、胰岛素类用量、口服化学类用量比较，差异有统计学意义（P<0.05）。20 152例糖尿病患者中，12 360例（61.33%）进行血糖监测，人均年监测频率为3次。不同年龄糖尿病患者不同血糖监测方式占比比较，差异有统计学意义（P<0.05）。注射胰岛素类药物的糖尿病患者HbA1c达标率（理想目标值与良好目标值）低于口服降血糖类药物人群（P<0.05）。结论　上海某区基层社区中降血糖药种类基本齐全，使用相对合理；社区糖尿病患者首位使用药物是双胍类，其次为磺酰脲类，以磺酰脲类和双胍类单用或联用占绝对多数；在胰岛素使用方面极不合理，在社区糖尿病人群中胰岛素治疗未能发挥应有的疗效；糖尿病人群服药率低，服药依从性差、连续性血糖监测率低。

关键词: 糖尿病, 降血糖药, 用药频度, 合理用药