Macrovascular risk factors in patients with diabetes: physician treatment strategies and extent of control.
Macrovascular risk factors in patients with diabetes: physician treatment strategies and extent of control.
复制标题
糖尿病患者的大血管危险因素：医生治疗策略和控制程度。
DOI：
10.4158/ep.11.3.172
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
C. Alexander
中科院分区：
文献类型：
--
作者：
R. Bergenstal;Soma S. Nag;J. Reusch;S. Sajjan;C. Alexander
客观的
描述目前医生用于解决糖尿病患者大血管危险因素的方法及其对糖化血红蛋白 (HbA1c)、血压和胆固醇（低密度脂蛋白胆固醇 [LDL-C]）目标实现的影响。
方法
由 133 名社区医生护理的新转诊或诊断的糖尿病患者 (N = 1,808) 参加了一项为期 12 个月的前瞻性多中心观察研究。受邀医生治疗了大量糖尿病患者，其中包括内分泌科医生、内科医生和初级保健医生。在入组时记录了患者和医生的特征、治疗策略优先顺序的医生排名以及最受关注的糖尿病相关并发症的患者排名。对总体和最常发生的治疗策略的血糖（HbA1c <7%）、胆固醇（LDL-C <100 mg/dL）和血压（低于 130/80 mm Hg）的后续治疗率和目标实现率进行了检查。
结果
在评估了参与该研究的患者的代谢特征后，医生将 67.6% 的患者的最高治疗优先级分配给了血糖控制。 12 个月随访期间，血糖控制的治疗率最高（87.2%），其次是血压管理（77.9%）和血脂控制（63.9%）。在接受治疗的患者中，HbA1c、LDL-C 和血压的目标实现率分别为 57.6%、47.7% 和 22.8%。无论治疗策略如何，HbA1c 的随访目标实现率最高（54.8% 至 72.3%），其次是 LDL-C（41.7% 至 48.4%），血压最低（12.0% 至 37.1%）。
结论
这些发现表明需要采取强调血糖、血压和胆固醇联合治疗的策略，以便更有效地控制糖尿病患者的微血管和大血管危险因素。
OBJECTIVE
To describe current approaches used by physicians to address macrovascular risk factors among patients with diabetes and their effect on glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol (low-density lipoprotein cholesterol [LDL-C]) goal attainment.
METHODS
Newly referred or diagnosed patients with diabetes (N = 1,808) under the care of 133 community physicians were enrolled in a 12-month prospective multi-center observational study. The invited physicians treat a large number of patients with diabetes and included endocrinologists, internists, and primary care physicians. Patient and physician characteristics, physician ranking of treatment strategy priority, and patient ranking of diabetes-related complications of greatest concern were recorded at enrollment. Follow-up treatment rates and goal attainment rates for glucose (HbA1c <7%), cholesterol (LDL-C <100 mg/dL), and blood pressure (less than 130/80 mm Hg) were examined, both overall and for the most frequently occurring treatment strategies.
RESULTS
After evaluating the metabolic profiles of patients enrolled in the study, physicians assigned the highest treatment priority to glucose control for 67.6% of patients. Treatment rates during the 12-month follow-up were highest for glycemic control (87.2%), followed by blood pressure management (77.9%), and lipid control (63.9%). Among treated patients, goal attainment for HbA1c, LDL-C, and blood pressure was 57.6%, 47.7%, and 22.8%, respectively. Regardless of treatment strategy, follow-up goal attainment was the highest for HbA1c (54.8% to 72.3%), followed by LDL-C (41.7% to 48.4%), and lowest for blood pressure (12.0% to 37.1%).
CONCLUSION
These findings suggest the need for strategies that emphasize combined glucose, blood pressure, and cholesterol treatment in order to achieve more effective control of microvascular and macrovascular risk factors among patients with diabetes.