Cardiovascular disease prevention practices by U.S. Physicians for patients with diabetes.
Cardiovascular disease prevention practices by U.S. Physicians for patients with diabetes.
复制标题
美国医生对糖尿病患者的心血管疾病预防实践。
DOI：
10.1111/j.1525-1497.2000.03079.x
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发表时间：
2000
影响因子：
5.7
通讯作者：
Stafford,RS
中科院分区：
文献类型：
--
作者：
Meigs,JB;Stafford,RS
目的：心血管疾病占 2 型糖尿病患者发病率和死亡率的大部分。我们描述了美国办公室医生对糖尿病患者采用的心血管疾病一级预防实践的模式。 测量和主要结果：我们分析了 1995 年和 1996 年国家门诊医疗调查 (NAMCS) 中 14,038 次就诊的代表性样本，其中包括 1,489 次就诊的糖尿病患者。医生填写了描述诊断、人口统计、提供的服务和当前药物治疗的就诊表格。糖尿病是通过诊断代码来定义的；患有缺血性心脏病或年龄小于30岁的患者被排除在外。我们使用 NAMCS 抽样权重通过外推法估算了全国访问量。使用多元逻辑回归评估预防实践的独立决定因素。 1995 年和 1996 年的实际就诊次数估计为 4.07 亿次就诊，其中 4480 万次（11%）是糖尿病患者。总体而言，糖尿病患者比非糖尿病患者接受了更多的心血管疾病预防服务，包括降低胆固醇（8% vs 5%，P<.001）和运动咨询（22% vs 13%，P<.001）、血压测量（82% vs 72%，P<.001）和阿司匹林处方（5% vs 2%，P<.001）。患有糖尿病和高脂血症的患者比没有这些诊断的患者更有可能接受降脂药物（67% vs 51%，P=0.007），但患有糖尿病和高血压或吸烟的患者接受降压药物或戒烟咨询的可能性并不比没有这些患者更高。这些影响在控制了潜在混杂因素的多重逻辑回归分析中仍然存在。结论：1995 年和 1996 年去看美国医生的糖尿病患者比非糖尿病患者接受了更多的心血管疾病预防服务。然而，服务的绝对率仍然低于根据国家建议所期望的水平。目前的证据表明，更广泛地实施这些建议有望减轻糖尿病患者的心血管疾病负担。
OBJECTIVE:Cardiovascular diseases account for the majority of morbidity and mortality in patients with type 2 diabetes mellitus. We describe patterns of cardiovascular disease primary prevention practices used for patients with diabetes by U.S. office-based physicians.MEASUREMENTS AND MAIN RESULTS:We analyzed a representative sample of 14,038 visits from the 1995 and 1996 National Ambulatory Medical Care Surveys (NAMCS), including 1,489 visits by patients with diabetes. Physicians completed visit forms describing diagnoses, demographics, services provided, and current medications. Diabetes was defined by diagnostic codes; patients with ischemic heart disease or younger than 30 years were excluded. We estimated national visit volumes by extrapolation using NAMCS sampling weights. Independent determinants of prevention practices were evaluated using multiple logistic regression. Actual visits sampled translated into an estimated 407 million office visits in 1995 and 1996, of which 44.8 million (11%) were by patients with diabetes. Overall, patients with diabetes received more cardiovascular disease prevention services than patients without diabetes, including cholesterol reduction (8% vs 5%,P<.001) and exercise counseling (22% vs 13%,P<.001), blood pressure measurement (82% vs 72%,P<.001), and aspirin prescription (5% vs 2%,P<.001). Patients with diabetes and hyperlipidemia were more likely to receive lipid-lowering medications than patients without these diagnoses (67% vs 51%,P=.007), but those who had diabetes and hypertension or who smoked were no more likely than those without to receive antihypertensive medications or smoking cessation counseling, respectively. These effects persisted in multiple logistic regression analyses controlling for potential confounders.CONCLUSIONS:Patients with diabetes visiting U.S. physicians in 1995 and 1996 received somewhat more cardiovascular disease prevention services than patients without diabetes. Absolute rates of services, however, remained lower than desired based on national recommendations. Current evidence suggests that wider implementation of these recommendations can be expected to reduce the burden of cardiovascular disease in patients with diabetes.