Clinical Care Among Individuals with Prediabetes in Primary Care: a Retrospective Cohort Study.
Clinical Care Among Individuals with Prediabetes in Primary Care: a Retrospective Cohort Study.
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DOI：
10.1007/s11606-022-07412-9
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发表时间：
2022-12
影响因子：
5.7
通讯作者：
Segal JB
中科院分区：
文献类型：
--
作者：
Tseng E;Durkin N;Clark JM;Maruthur NM;Marsteller JA;Segal JB
自2000年以来，美国普通人群的糖尿病发病率（2018年为每1000名成年人6.7人）没有显著变化，这表明糖尿病前期患者与循证干预措施无关。我们试图描述糖尿病前期个体的临床护理，确定与这种护理相关的患者因素，并评估糖尿病发展的风险。使用关联索赔和电子健康记录数据的回顾性队列研究。我们基于实验室测量建立了一个糖尿病前期成人队列。我们排除了既往有糖尿病史、6个月内怀孕或近期使用类固醇的患者。我们测量了队列进入后12个月内针对糖尿病前期管理和糖尿病发病率的临床服务的订购和完成情况。我们使用二元和多元逻辑回归测试了个体特征与感兴趣结果之间的关联强度。我们的队列包括3888例实验室诊断为前驱糖尿病（偶发或流行前驱糖尿病）的患者。在12个月内，63.4%的人重复进行血糖检测，但只有10.4%的人被诊断为糖尿病前期，1.0%的人被转诊接受营养服务，5.4%的人被开了二甲双胍。大多数患者在转诊时完成实验室检查和营养访视，并在处方时填写二甲双胍。血糖水平或BMI较高的个体更有可能接受糖尿病前期临床护理。6%的人在进入队列的12个月内患上糖尿病，血糖水平较高，BMI ≥ 30 kg/m2。在调整后的模型中，黑人患糖尿病的几率是白色人的1.4倍。糖尿病前期临床护理活动的比率很低，而且没有改善。迫切需要改善糖尿病前期护理的策略，从而预防或延迟糖尿病的发生。在线版本包含补充材料，可通过10.1007/s11606-022-07412-9获得。
The incidence of diabetes in the general US population (6.7 per 1000 adults in 2018) has not changed significantly since 2000, suggesting that individuals with prediabetes are not connecting to evidence-based interventions. We sought to describe the clinical care of individuals with prediabetes, determine patient factors associated with this care, and evaluate risk for diabetes development. Retrospective cohort study using linked claims and electronic health record data. We created a cohort of adults with prediabetes based on laboratory measures. We excluded patients with a prior history of diabetes, pregnancy in prior 6 months, or recent steroid use. We measured ordering and completion of clinical services targeting prediabetes management and diabetes incidence within 12 months following cohort entry. We tested the strength of the association between individuals’ characteristics and outcomes of interest using bivariate and multiple logistic regression. Our cohort included 3888 patients with a laboratory diagnosis of prediabetes (incident or prevalent prediabetes). Within 12 months, 63.4% had repeat glycemic testing, yet only 10.4% had coded diagnoses of prediabetes, 1.0% were referred for nutrition services, and 5.4% were prescribed metformin. Most patients completed labs and nutrition visits when referred and filled metformin when prescribed. Individuals with a higher glycemic level or BMI were more likely to receive prediabetes clinical care. Six percent of individuals developed diabetes within 12 months of cohort entry and had higher glycemic levels and BMI ≥ 30 kg/m2. In the adjusted model, Black individuals had 1.4 times higher odds of developing diabetes than White individuals. Rates of prediabetes clinical care activities are low and have not improved. Strategies are urgently needed to improve prediabetes care delivery thereby preventing or delaying incident diabetes. The online version contains supplementary material available at 10.1007/s11606-022-07412-9.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
影响因子：
13.8
作者：
Ali, Mohammed K.;Bullard, Kai McKeever;Gregg, Edward W.
通讯作者：
Gregg, Edward W.
影响因子：
5.7
作者：
Speaker, Sidra L.;Rastogi, Radhika;Rothberg, Michael B.
通讯作者：
Rothberg, Michael B.
DOI：
10.1016/s0140-6736(12)60283-9
发表时间：
2012-06-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
Tabák AG;Herder C;Rathmann W;Brunner EJ;Kivimäki M
通讯作者：
Kivimäki M
影响因子：
16.2
作者：
Schmittdiel, Julie A.;Adams, Sara R.;O'Connor, Patrick J.
通讯作者：
O'Connor, Patrick J.