Patient adherence improves glycemic control
Patient adherence improves glycemic control
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DOI：
10.1177/0145721705274927
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发表时间：
2005-03-01
影响因子：
3.9
通讯作者：
Phillips, LS
中科院分区：
文献类型：
--
作者：
Rhee, MK;Slocum, W;Phillips, LS
目的探讨糖尿病患者遵约和服药依从性对糖化血红蛋白（HbA 1c）的影响。方法回顾性分析1991 ~ 2001年1560例2型糖尿病患者在格雷迪糖尿病门诊就诊并随访1年后的HbA 1c。预约保持率通过预定干预访视的次数进行评估，药物依从性通过自我报告的糖尿病药物使用在前一次访视时被推荐的百分比进行评估。结果患者平均年龄为55岁，体重指数（BMI）为32 kg/m2，糖尿病病程为4.6年，基线HbA 1c为9.1%。90%是非洲裔美国人，63%是女性。那些保持更多干预预约的人在12个月的护理后HbA 1c水平较低（7. 6%，6-7次干预访视vs 9. 7%，0次干预访视）。更好的药物依从性也与12个月护理后较低的HbA 1c水平相关（7.8%，依从性为76%-100%）。在多变量线性回归分析中调整了年龄、性别、种族、BMI、糖尿病病程和糖尿病治疗后，预约和药物依从性的益处仍然显著，并且是独立贡献的;每增加一次预约，HbA 1c降低0.12（P = 0.0001）和0.34%降低每四分位数更好的药物治疗依从性（P = 0.0009）。结论保持更多的预约和服用糖尿病药物的指示与HbA 1c的显着改善。提高血糖结果的努力应包括强调患者依从性的这些简单但至关重要的方面。
Purpose The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c.Methods A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after I year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit.Results The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m(2), diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P =.0001) and 0.34% lower for each quartile of better medication adherence (P =.0009).Conclusion Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.