Impact of changes in HbA1c, lipids and blood pressure on long-term outcomes in type 2 diabetes patients:: An analysis using the CORE Diabetes Model
Impact of changes in HbA1c, lipids and blood pressure on long-term outcomes in type 2 diabetes patients:: An analysis using the CORE Diabetes Model
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DOI：
10.1185/030079903125002611
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发表时间：
2004-08-01
影响因子：
2.3
通讯作者：
Spinas, GA
中科院分区：
文献类型：
--
作者：
Palmer, AJ;Roze, S;Spinas, GA
目的：各种因素影响2型糖尿病患者并发症的风险。单个风险因素对长期结局的孤立影响尚不清楚。本研究的目的是计算总胆固醇（T-CHOL）、高密度脂蛋白胆固醇（HDL）、收缩压（SBP）、糖化血红蛋白（HbA（1c））以及所有四个参数组合的基线水平改善10%对预期寿命（LE）、质量调整LE（QALE）和并发症总成本（TC）的预计影响。定义了一个新诊断患者队列（基线年龄52岁，HbA（1c）9.1%，SBP 137 mmHg，T-CHOL 212 mg/dL和HDL 39 mg/dL）。CORE糖尿病模型用于模拟LE、QALE和TC（美国第三方付款人的观点，每年折现3%），假设风险因素没有变化，每个参数单独改善10%，或所有参数同时改善10%。结果：HbA（1c）改善导致LE和QALE分别增加1.00年和0.81年，TC降低10，800美元/患者。SBP改善导致LE和QALE分别改善0.67和0.55年，TC降低7，049美元。T-CHOL降低导致LE和QALE分别改善0.29和0.20年，TC增加1，923美元。增加HDL导致LE和QALE分别改善0.28和0.18年，并增加TIC 2，162美元。所有参数的同时改善导致预计LE和QALE分别改善2.17和1.72年，TIC减少14，533美元。结论：HbA（1c）、血脂水平和SBP的联合改善在LE、QALE和TC方面产生最大的益处。HbA（1c）改善10%对这三个结果的影响最大。
Objectives: Various factors influence the risk of complications in type 2 diabetes patients. The isolated impact of single risk factors on long-term outcomes is unclear. The aim of this study was to calculate the projected effects on life expectancy (LE), quality-adjusted LE (QALE) and total costs of complications (TC) of 10% improvements in baseline levels of either total cholesterol (T-CHOL), high-density lipoprotein cholesterol (HDL), systolic blood pressure (SBP), glycosylated haemoglobin (HbA(1c)), and all four parameters combined.Methods: A cohort of newly diagnosed patients (baseline age 52 years, HbA(1c) 9.1%, SBP 137 mmHg, T-CHOL 212 mg/dL, and HDL 39 mg/dL) was defined. The CORE Diabetes Model was used to simulate LE, QALE and TC (US third-party payer perspective discounted at 3% annually) over patients' lifetimes, assuming no change in risk factors, an isolated 10% improvement in each parameter, or a 10% improvement in all parameters simultaneously.Results: Improved HbA(1c) led to increases in LE and QALE of 1.00 and 0.81 years respectively, and decreased TC of (US) $10,800/patient. Improved SBP led to improvements in LE and QALE of 0.67 and 0.55 years respectively and decreased TC of $7,049. Decreased T-CHOL led to improvements in LE and QALE of 0.29 and 0.20 years, respectively, and increased TC of $1,923. Increased HDL led to improvements in LE and QALE of 0.28 and 0.18 years respectively, and increased TIC of $2,162. Simultaneous improvements in all parameters led to projected improvements in LE and QALE of 2.17 and 1.72 years respectively, and decreased TIC of $14,533.Conclusions: Combined improvements in HbA(1c), lipid levels and SBP produced the greatest benefits in terms of LE, QALE and TC. A 10% improvement in HbA(1c) had the greatest impact on these three outcomes.