Case-control study of 10 years of comprehensive diabetes care
Case-control study of 10 years of comprehensive diabetes care
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DOI：
10.1136/ewjm.172.2.85
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发表时间：
2000-02-01
期刊：
影响因子：
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通讯作者：
Glauber, HS
中科院分区：
文献类型：
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作者：
Brown, JB;Nichols, GA;Glauber, HS
目的描述在整个卫生系统中为糖尿病患者制定的综合管理计划的长期临床影响。设计10年病例对照评价。地址：Kaiser Permanente Northwest，波特兰，OR.参与者1987年至1996年期间健康维护组织的成员;将糖尿病成员与同等数量的非糖尿病成员进行比较。糖尿病患者人数从1987年的5331人到1996年的13,099人不等。主要观察指标糖尿病登记人数、死亡率、合并症变化、预防性健康措施的采用率、药物使用、危险因素水平、每年每千人住院天数、每年每千人急诊就诊次数。结果该人群糖尿病患病率从2.54%上升到2.54%，（7，895/310，819），1987年降至3.66%（14，741/402，754），确诊时的平均（SEM）年龄从62.9（+/-0.21）岁降至62.0（+/-0.13）岁（P < 0.05）。到1996年，13，099人中的10，885人（83% +/-0.3%）的糖尿病患者每年进行一次实验室检查以评估血糖控制情况，视网膜病变的年筛查率为67.6%。（+/-0.4%），流感疫苗接种率为60.2%（7，886/13，099），肾病筛查率为43%（5，698/13，099）（+/-0.49%）。家庭血糖检测的使用从糖尿病患者的32.4%（1721/5331）增加到53.0%（6,942/12,099）;降脂药物的使用从3.5%（187/55,331）增加到13.8%（2,594/13,099）。使用血管紧张素转换酶抑制剂的糖尿病患者从8.5%增加到34.8%。平均血压从144/82 mmHg（+/-0.8/0.4）降至138/79 mmHg（+/-0.3/0.15），平均总胆固醇浓度从243 mg/dL（+/-4.2）降至215 mg/dL（+/-0.6）。到1996年，56.4%（7，388/1，3099）（+/-0.5%）的糖尿病注册会员血糖控制良好至极好（HbA（1c））
Objective To describe the long-term clinical impact of a comprehensive management program instituted throughout a health system for members with diabetes mellitus. Design 10 year case-control evaluation. Setting Kaiser Permanente Northwest, Portland, OR. Participants Members of the health maintenance organization between 1987 and 1996; members with diabetes were compared with equal numbers of members without diabetes. The number of participants with diabetes ranged from 5331 in 1987 to 13,099 in 1996. Main outcome measures Number in diabetes register, mortality, change in comorbidity, rates of uptake of preventive health measures, use of pharmaceuticals, levels of risk factors, hospital days per thousand per year, emergency room visits per thousand per year. Results The prevalence of diabetes identified in this population rose from 2.54% (7,895/310,819) in 1987 to 3.66% (14,741/402,754) in 1996,and the mean (SEM) age of members at the time of diagnosis fell slightly from 62.9 (+/-0.21) years to 62.0 (+/-0.13) years (P < 0.05). By 1996, 10,885 of the 13,099 (83% +/-0.3%) of members with diabetes had an annual laboratory test to assess glycemic control, the annual screening rate for retinopathy was 67.6% (+/-0.4%), the rate of uptake of influenza immunizations was 60.2% (7,886/13,099) and the screening rate for nephropathy was 43% (5,698/13,099) (+/-0.49%). The use of home glucose testing increased from 32.4% (1721/5331) of members with diabetes to 53.0% (6,942/12,099); the use of lipid lowering drugs increased from 3.5% (187/55,331) to 13.8% (2,594/13,099). The use of angiotensin converting enzyme inhibitors increased from 8.5% to 34.8% of members with diabetes. Mean blood pressure decreased from 144/82 mm Hg (+/-0.8/0.4) to 138/79 mm Hg (+/-0.3/0.15), and mean total cholesterol concentrations dropped from 243 mg/dL (+/-4.2) to 215 mg/dL (+/-0.6). By 1996, 56.4% (7,388/1,3099) (+/-0.5%) of members on the diabetes register had good to excellent glycemic control (HbA(1c)