Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care
Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care
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DOI：
10.1023/b:ejep.0000032351.42772.e7
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发表时间：
2004-06-01
影响因子：
13.6
通讯作者：
Rutten, GEHM
中科院分区：
文献类型：
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作者：
Goudswaard, AN;Stolk, RP;Rutten, GEHM
在一般实践中，许多糖尿病患者不能实现良好的血糖控制。本研究的目的是评估在初级保健中接受治疗的2型糖尿病患者的哪些特征可预测血糖控制不佳（HbA（1c）大于或等于7%）。从病历中收集数据。1641例患者入选，平均HbA（1c）7.1（SD 1.7）%，42%的患者HbA（1c）大于或等于7%。单因素分析显示，年龄较小、糖尿病病程较长、诊断时血糖水平较高、最近空腹血糖（FBG）、总胆固醇和甘油三酯水平较高、体重指数（BMI）较高、口服降糖药（OHA）治疗、胰岛素治疗、过去一年因糖尿病GP就诊次数较多、教育水平较低与血糖控制不良相关。在多元线性回归和多元逻辑回归中，FBG水平较高（比值比（OR）：= 1.6，95%置信区间（CI）：1.49，1.70），OHA治疗OR：2.1，95% CI：1.41，3.04），胰岛素治疗（OR：7.2，95%CI：4.18，12.52）、低文化程度（OR：1.26，95%CI：1.01，1.56）与低水平HbA1c独立相关。当FBG水平从模型中排除时，诊断时较高的血糖，较高的甘油三酯和总胆固醇值以及较年轻的年龄预测血糖控制不良，但这些变量仅解释了HbA变化的15%（1c）。总之，在一般实践中，从糖尿病患者的患者特征预测血糖控制不良几乎是不可能的。FBG似乎是HbA（1c）的一个强有力的预测因子，这强调了这个简单的测试在日常糖尿病护理中的有用性。OHA或胰岛素治疗组的代谢控制较差，这表明目前的治疗方案可能不足以达到治疗目标。糖尿病护理提供者应关注教育水平较低的患者。
Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA(1c) greater than or equal to7%). Data were collected from the medical records. 1641 patients were included who had mean HbA(1c) 7.1( SD 1.7)%, and 42% had HbA(1c) greater than or equal to7%. On univariate analysis younger age; longer duration of diabetes; higher levels of blood glucose at diagnosis; most recent fasting blood glucose (FBG), total cholesterol, and triglyceride; higher body mass index (BMI); treatment with oral hypoglycaemic agents (OHA); treatment with insulin; more GP-visits for diabetes in the last year; and lower educational level were associated with poor control. Both in multiple linear regression and in multiple logistic regression higher levels of FBG ( odds ratio ( OR): = 1.6, 95% confidence interval (CI): 1.49, 1.70), treatment with OHA OR: 2.1, 95% CI: 1.41, 3.04), treatment with insulin ( OR: 7.2, 95% CI: 4.18, 12.52), lower educational level ( OR: 1.26, 95% CI: 1.01, 1.56) were independently associated with poor levels of HbA(1c). When FBG levels were excluded from the model, higher blood glucose at diagnosis, higher values for triglyceride and total cholesterol, and younger age predicted poor glycaemic control, but these variables explained only 15% of the variation in HbA(1c). In conclusion prediction of poor glycaemic control from patient characteristics in diabetic patients in general practice is hardly possible. FBG appeared to be a strong predictor of HbA(1c), which underlines the usefulness of this simple test in daily diabetes care. The worse metabolic control in those treated with either OHA or insulin suggests that current treatment regimes might be not sufficiently applied to reach the targets of care. Providers of diabetes care should be attentive to patients with lower educational level.