Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
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DOI：
10.1371/journal.pone.0092458
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Farmer AJ
中科院分区：
文献类型：
--
作者：
Hirst JA;Stevens RJ;Farmer AJ
目前关于监测血糖控制时重新检测HbA1c所需时间间隔的指导是基于专家意见，而不是基于有力的研究。我们工作的目的是探索在改变降糖药物后HbA1c的变化有多快。这意味着12周前的常规HbA1c检测间隔是否可以为糖尿病药物调整提供信息。这项为期12周的队列研究招募了来自英国18个普通诊所的非胰岛素治疗糖尿病患者，这些患者正在开始或改变口服降糖药物的剂量。在基线和招募后2、4、8和12周测量HbA1c。早期HbA1c水平与12周HbA1c水平相关。采用ROC曲线分析确定8周阈值，超过该阈值的药物调整在临床上可能是合适的。研究招募了93名患者。79例患者用药不变，随访满12周，基线特征如下：平均±标准差年龄61.3±10.8岁，34%为女性，糖尿病病程6.0±4.3年。基线、2、4、8、12周平均HbA1c分别为8.7±1.5%、（72.0±16.8 mmol/mol） 8.6±1.6%（70.7±17.0 mmol/mol）、8.4±1.5%（68.7±15.9 mmol/mol）、8.2±1.4%（66.3±15.8 mmol/mol）和8.1±1.4%（64.8±15.7 mmol/mol）。在研究结束时，61%的患者血糖控制不理想（HbA1c为7.5%或59 mmol/mol）。8周的变化与12周的HbA1c变化显著相关，8周时HbA1c高于8.2% （66 mmol/mol）正确分类了所有28例12周未达到血糖控制的患者。这是第一个具有足够能力来检查HbA1c短期变化的研究。在药物改变后8周，可以预测12周内HbA1c的变化。许多在12周后血糖未得到控制的参与者可能从早期的HbA1c检查和药物治疗中受益。
Current guidance about the interval needed before retesting HbA1c when monitoring for glycaemic control is based on expert opinion rather than well-powered studies. The aim of our work was to explore how fast HbA1c changes after a change in glucose-lowering medication. This has implications for whether routine HbA1c testing intervals before 12 weeks could inform diabetes medication adjustments. This 12-week cohort study recruited patients from 18 general practices in the United Kingdom with non-insulin treated diabetes who were initiating or changing dose of oral glucose-lowering medication. HbA1c was measured at baseline and 2, 4, 8 and 12 weeks after recruitment. HbA1c levels at earlier time intervals were correlated with 12-week HbA1c. A ROC curve analysis was used to identify the 8-week threshold above which medication adjustment may be clinically appropriate. Ninety-three patients were recruited to the study. Seventy-nine patients with no change in medication and full 12-week follow-up had the following baseline characteristics: mean±standard deviation age of 61.3±10.8 years, 34% were female and diabetes duration of 6.0±4.3 years. Mean HbA1c at baseline, 2, 4, 8 and 12 weeks was 8.7±1.5%, (72.0±16.8 mmol/mol) 8.6±1.6% (70.7±17.0 mmol/mol), 8.4±1.5% (68.7±15.9 mmol/mol), 8.2±1.4% (66.3±15.8 mmol/mol) and 8.1±1.4% (64.8±15.7 mmol/mol) respectively. At the end of the study 61% of patients had sub-optimal glycaemic control (HbA1c>7.5% or 59 mmol/mol). The 8-week change correlated significantly with the 12-week change in HbA1c and an HbA1c above 8.2% (66 mmol/mol) at 8 weeks correctly classified all 28 patients who had not achieved glycaemic control by 12 weeks. This is the first study designed with sufficient power to examine short-term changes in HbA1c. The 12-week change in HbA1c can be predicted 8 weeks after a medication change. Many participants who had not achieved glycaemic control after 12 weeks may have benefitted from an earlier review of their HbA1c and medication.
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DOI：
10.1111/jch.12037
发表时间：
2013-02
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Muntner P;Levitan EB;Joyce C;Holt E;Mann D;Oparil S;Krousel-Wood M
通讯作者：
Krousel-Wood M
影响因子：
5.8
作者：
Bosi, E.;Dotta, F.;Goodman, M.
通讯作者：
Goodman, M.
影响因子：
2.5
作者：
Berard, Lori D.;Blumer, Ian;Woo, Vincent
通讯作者：
Woo, Vincent
影响因子：
105.7
作者：
Stratton, IM;Adler, AI;Holman, RR
通讯作者：
Holman, RR
影响因子：
3.4
作者：
Kilpatrick, E. S.
通讯作者：
Kilpatrick, E. S.