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1、CODIC-中国大城市治疗2型糖尿病及其并发症的成本研究CODIC - Cost of Treating Type2 Diabetes & complications in urban China,糖尿病的流行病学特征Diabetes Epidemiology,1995-2025年间，全球糖尿病患者已由1.35亿增长到3.0亿，表明糖尿病患病率将增长27%，一般成年人群的预期增长率为11%全球2型糖尿病病例占所有糖尿病的90%(中国为95%),中国2型糖尿病患病率Type2 Diabetes prevalence in China,中国糖尿病的患病率估计为3.21%中国城市地区的患病率估计为4
2、.8%武汉、沈阳和西安，采用全国的糖尿病患病率4.8%总人群中，30%的患者确诊确诊糖尿病病人中，40%得到治疗,2型糖尿病并发症Type2 Diabetes complications,2型糖尿病并发症对许多器官系统有直接损害，尤其是长期并发症，导致发病率和死亡率升高并发症分为两类：大血管病变:心血管疾病和脑血管疾病微血管病变:视网膜病、肾病、神经病,糖尿病的并发症增加危险性Diabetes complications increase risk,糖尿病病人患心脏病和中风的危险度比非糖尿病病人高4倍2型糖尿病、高血压病人比非糖尿病、非高血压病人的死亡率高7倍糖尿病性视网膜病变是经济发达国家成
3、年人失明和视觉失能的首要原因糖尿病性肾病占终末期肾衰的40%糖尿病患者低位截肢的危险度比非糖尿病病人高40%,CODIC研究方法CODIC methodology,中国有11个省会城市参与了CODIC项目：CODIC covers 11 provincial capital Chinese cities: 北京、上海、广州、成都、武汉、沈阳、南京、济南、西安、重庆、杭州Beijing, Shanghai, Guangzhou, Chengdu, Wuhan, Shenyang, Nanjing, Jinan, Xian, Chongqing, Hangzhou采访了200名内分泌专家Inter
4、views of 200 endocrinologists 4000名糖尿病病人填写了调查问卷4000 Diabetes Patient Forms completed进一步采访了806名有并发症的2型糖尿病病人和300名无并发症的糖尿病病人Further 806 Type2 diabetes patients with complications and 300 diabetic patients without complications interviewed,2型糖尿病患者抽样调查问卷Type2 Diabetes patient sample questionnaire,所有的费用的数
5、据来自对病人的访问All Cost data derived from Patient interviews请问您是否患有2型糖尿病的并发症? *Do you suffer from diabetic complications due to T2DM ?*您患有下列哪些并发症和或在过去的一年中接受过哪些治疗？Which of these complications or procedures you are currently suffering from/have you undergone in the last year ? (complications as listed in ne
6、xt slide)在过去的一年中您由于2型糖尿病及其并发症住过几次医院？History of any hospitalisation due to T2DM or its complications during the last year ?在过去的一年中您由于2型糖尿病及其并发症您看过几次门诊？Number of medical consultations due to T2DM or its complications in the last year ?,2型糖尿病病人的人口统计学特征Type2 Diabetes patient demographics,病人的平均年龄为58岁Pati
7、ent Mean age is 58 years old.糖尿病平均病程约为6年Mean average duration of diabetes is about 6 years.2型糖尿病的平均体重指数（BMI）为24kg/m2Mean average BMI of T2DM patients is 24 kg/m2WHO提出亚洲人的体重指数正常范围为18.5-23 kg/m2WHO range for acceptable, normal, or optimum body-mass index (BMI) for Asian populations should be narrowed
8、to 185-23 kg/m2, Message : 2型糖尿病人群有肥胖倾向Type2 Diabetes population has a propensity for obesity.,血糖控制Glycaemic control,32%的病人血糖控制差-HbAIc7.5%32% of patients have poor glycemic control (defined as HbAIc 7.5)只有47%口服降糖药治疗病人和37%胰岛素治疗的病人得到很好的血糖控制Only 47% of patients on OHA and 37% on insulin had “good” glyc
9、emic control采用饮食和运动治疗的病人平均HbAIc为7.23%, 口服降糖药治疗的病人为7.43% ，而胰岛素治疗的病人为8.25%Patients treated with diet and exercise had a mean HbAIc of 7.23%, compared to patients on OHA with 7.43% and patients on insulin with 8.25%Message: 大多数病例表现出渐进性细胞功能衰退、口服降糖药治疗失败而不能维持血糖控制,ISIS Diabetic Therapy Monitor PhVI 2002Ame
10、rican Diabetic Association guidelines,大城市2型糖尿病病人的大血管并发症的患病率,大城市2型糖尿病病人的大血管并发症的患病率Prevalence of T2DM,0.4%,0.8%,4.1%,4.0%,18.6%,11.1%,10.0%,0.0%,5.0%,10.0%,15.0%,20.0%,CABG,PTCA,CHF,AMI,心绞痛Angina,卒中Stroke,TIA,53.32%的糖尿病病人至少患有一种并发症微血管并发症： 22.33%大血管并发症：13.30%两者兼有：17.69%,2型糖尿病并发症,2型糖尿病并发症的危险性,100%,2型糖尿病并
11、发症-平均住院天数,2型糖尿病并发症-平均住院天数,中国大城市II 型糖尿病直接医疗总成本,中国城市治疗2型糖尿病及其并发症的直接医疗总成本为189.42亿RMB* (3.759亿城市人口)Total Direct Medical Cost of treating T2DM and its complication in urban China is billion RMB (US$2.29billion) (375.9m pop) (CODE2: 欧洲治疗1000万名以上2型糖尿病病人的直接医疗成本为290亿欧元)(CODE2: Direct medical cost for 10milli
12、on patients with Type II DM is 29 billion Euros( US$29.9billion).该费用占医疗卫生总费用的3.98%（4764亿RMB ）This accounts for 3.98% of total China healthcare expenditure (476.4 billion RMB).(CODE2: 5%医疗卫生总费用)(CODE2: 5% of total healthcare expenditure).,该费用计算包括：,仅包括中国大城市人口（3.759亿人）Only Chinas urban population is in
13、cluded ( 375.9 million)糖尿病患病率4.8%，其中95%为2型糖尿病Using diabetes prevalence rate of 4.8% of which 95% of all Diabetes are Type 2 Diabetes只有30%病人得到诊断，得到诊断的病人中40%接受治疗（诊断并治疗的病人占12%）Only 30% of patients are diagnosed of which 40% of patients get treated ( Diagnosed and treated is 12% of total)46.7%的2型糖尿病患者无并
14、发症46.7%of T2DM patients do not have complications53.3%的2型糖尿病患者有并发症53.3% of T2DM patients have complications,2 型糖尿病占总医疗卫生费用的比较:中国欧洲,中国大城市2型糖尿病直接医疗总成本,治疗无并发症2型糖尿病的直接医疗成本35.78亿元人民币Direct medical cost of treating Type2 Diabetes without complications is 3.578 billion RMB.治疗有并发症2型糖尿病的直接医疗成本153.64亿元人民币Dire
15、ct medical cost of treating Type2 Diabetes with complications is RMB 15.364 billion.该费用占大城市治疗2型糖尿病直接医疗成本的 81.1%This accounts for 81.1% of direct medical cost of treating T2DM in urban China.,中国治疗糖尿病病人的直接医疗成本,10亿元人民币Billion RMB,18.9%,81.1%,0.00%,50.00%,100.00%,直接医疗成本Direct Medical Cost,有并发症病人的直接医疗成本(
16、Direct Medical Cost for patients with complications,无并发症病人的直接医疗成本(Direct Medical Cost for patients without complications,每例病人的年均直接医疗成本,每例病人的年均直接医疗成本，无并发症者为3726.36元，有并发症者为14009.00元，治疗并发症比单纯治疗糖尿病的费用高3.8倍Average annual direct medical cost per patient was 3726.36 RMB without complications compared to 14
17、009.00 RMB for patients with complications. It cost 3.8 times more to treat DM patients with complications.(CODE2:有糖尿病并发症使治疗费用升高3.5倍)(CODE2: Presence of diabetic related complications increase the costs by over 3.5 times.年人均成本（3726.36元）占上海年人均可支配收入的32%，占西安年人均可支配收入的73%This cost (3726.36 RMB) could account for 32% of per capita disposable income in Shanghai and 73% of that in Xian.,
