A comprehensive assessment of the avoidability of long-term complications of diabetes - A case-control study
A comprehensive assessment of the avoidability of long-term complications of diabetes - A case-control study
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DOI：
10.2337/diacare.19.9.927
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发表时间：
1996-09-01
期刊：
影响因子：
16.2
通讯作者：
Olivieri, M
中科院分区：
文献类型：
--
作者：
Nicolucci, A;Cavaliere, D;Olivieri, M
目的-识别和量化糖尿病长期并发症的风险因素（即，严重的肢体缺血、截肢、慢性肾衰竭[肌酸酐>3 mg/dl]、透析治疗、增殖性视网膜病、失明），特别强调那些与护理质量相关的变量，可以认为是可避免的。研究设计和方法-我们设计了一项病例对照研究，纳入了886名患有长期糖尿病并发症的患者和1名，在6个月期间，来自35个糖尿病门诊和49个全科医生办公室的888名对照受试者没有并发症。选定的社会经济，病理生理，自我保健，卫生保健和生活方式的信息收集所有patients.RESULTS -Logistic回归分析表明，几个因素与糖尿病主要并发症的发展。在患者特征中，男性（比值比[OR] = 1.8，95% CI 1.4-2.3）和年龄（50 - 69岁患者的OR = 1.7，95% CI 1.2-2.3，而50岁以下患者的OR = 1.7，95% CI 1.2-2.3）与并发症风险增加相关。在临床变量中，糖尿病的类型和病程是糖尿病并发症的最重要的预测因素。高血压的存在也与糖尿病并发症的发生相关，特别是当治疗控制不佳时（OR = 3.1，95% CI 2.3-4.3）。需要帮助才能到达医疗机构的患者和不定期前往此类机构的患者发生并发症的风险较高（OR = 1.5，95% CI 1.2-1.9; OR = 1.7，95% CI 1.3-2.2）。教育方面也与结局相关：未接受任何教育干预的患者发生并发症的风险增加（OR = 4.1，95% CI 1.7-9.7），而胰岛素治疗的自我管理具有保护作用（OR = 0.6，95% CI 0.5-0.8）。与可避免的风险因素相关的汇总归因风险（即，不受控制的高血压、对就诊时间安排的依从性差、糖尿病教育不足、没有胰岛素治疗的自我管理）为0.39。结论-我们的数据表明，通过消除可避免的危险因素，糖尿病并发症的数量可以减少三分之一以上。病例对照方法是监测临床实践并将其与重要结果联系起来的有效方法。它可以帮助决策者确定摩罗有效的策略，并在定制具体的干预措施，旨在提高糖尿病患者的护理质量。
OBJECTIVE - To identify and quantify risk factors for the development of long-term diabetic complications (i.e., critical limb ischemia, amputation, chronic renal failure [creatinine >3 mg/dl], dialysis treatment, proliferative retinopathy, blindness), with particular emphasis on those variables that, being related to quality of care, can be considered avoidable.RESEARCH DESIGN AND METHODS - We designed a case-control study that enrolled 886 patients with long-term diabetic complications and 1,888 control subjects without complications from 35 diabetic outpatient clinics and 49 general practitioners' offices during a 6-month period. Selected socioeconomic, pathophysiologic, self-care, health care, and lifestyle information were collected for all patients.RESULTS - A logistic regression analysis showed that several factors are related to the development of major diabetic complications. Among patient characteristics, male sex (odds ratio [OR] = 1.8, 95% CI 1.4-2.3) and age (OR = 1.7, 95% CI 1.2-2.3 for patients between 50 and 69 years of age as opposed to those younger than 50 years of age) were associated with an increased risk of complication. Among clinical variables, the type and the duration of diabetes were the most important predictors of diabetic complications. The presence of hypertension was also associated with the development of diabetic complications, particularly when it was poorly controlled by treatment (OR = 3.1, 95% CI 2.3-4.3). Patients who needed help to reach a health care facility and those who did not regularly attend such a facility were at higher risk of developing complications (OR = 1.5, 95% CI 1.2-1.9; OR = 1.7, 95% CI 1.3-2.2, respectively). Educational aspects were also related to the outcome: patients who did not receive any kind of educational intervention had an increased risk of developing complications (OR = 4.1, 95% CI 1.7-9.7), while self-management of insulin therapy had a protective effect (OR = 0.6, 95% CI 0.5-0.8). The summary attributable risk related to avoidable risk factors (i.e., uncontrolled hypertension, poor compliance with visit scheduling, inadequate diabetes education, no selfmanagement of insulin treatment) was 0.39.CONCLUSIONS - Our data suggest that, by removing avoidable risk factors, the number of diabetic complications considered could be reduced by more than one-third. The case-control methodology represents an efficient way of monitoring clinical practice and relating it to important outcomes. It can be of help for policy makers in identifying the moro effective strategies and in tailoring specific interventions aimed at improving the quality of the care delivered to diabetic patients.