Treatment of Patients with Prediabetes in a Primary Care Setting 2011-2018: an Observational Study
Treatment of Patients with Prediabetes in a Primary Care Setting 2011-2018: an Observational Study
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DOI：
10.1007/s11606-020-06354-4
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发表时间：
2021-01-15
影响因子：
5.7
通讯作者：
Rothberg, Michael B.
中科院分区：
文献类型：
--
作者：
Speaker, Sidra L.;Rastogi, Radhika;Rothberg, Michael B.
背景资料：超过三分之一的美国成年人有患糖尿病的高风险，可以通过药物营养疗法（MNT）或二甲双胍等干预措施来延迟或预防。医生自我报告的糖尿病前期治疗率正在提高，但实际的转诊，处方和MNT visits的模式是unknown.Objective：为了表征治疗糖尿病前期在初级care.Design：我们进行了一项回顾性队列研究，使用电子健康记录数据。我们描述了治疗模式，并使用多变量逻辑回归来评估患者因素和PCP特异性治疗率与患者治疗的相关性。患者我们纳入了2011-2018年期间首次出现糖尿病前期血红蛋白A1 c（HbA 1c）范围并在一年内接受初级保健提供者（PCP）随访的超重或肥胖门诊患者。主要指标：我们收集了患者特征和以下治疗：二甲双胍处方;转诊至MNT、糖尿病教育、内分泌学或减肥药物;以及MNT访视。关键结果在16，713例糖尿病前期门诊患者中，20.4%接受了治疗，包括二甲双胍处方（7.8%）和MNT转诊（11.3%），但只有7.4%的转诊患者完成了MNT访视。治疗的最强预测因素是患者的PCP治疗率。一些PCP从未治疗过前驱糖尿病，但有两个治疗了一半以上的患者; 62%的患者没有完成MNT访视。年龄较小或女性以及体重指数或HbA 1c较高也与治疗呈正相关。与白色患者相比，黑人患者更有可能接受MNT转介，不太可能接受二甲双胍。结论几乎80%的新的前驱糖尿病患者从未接受过治疗，那些谁没有收到转介有非常差的访问完成。治疗率似乎反映了提供者而不是患者的偏好。
Background: Over one third of American adults are at high risk for developing diabetes, which can be delayed or prevented using interventions such as medical nutrition therapy (MNT) or metformin. Physicians' self-reported rates of prediabetes treatment are improving, but patterns of actual referral, prescription, and MNT visits are unknown.Objective: To characterize treatment of prediabetes in primary care.Design: We conducted a retrospective cohort study using electronic health record data. We described patterns of treatment and used multivariable logistic regression to evaluate the association of patient factors and PCP-specific treatment rate with patient treatment. Patients We included overweight or obese outpatients who had a first prediabetes-range hemoglobin A1c (HbA1c) during 2011-2018 and had primary care provider (PCP) follow-up within a year.Main Measures: We collected patient characteristics and the following treatments: metformin prescription; referral to MNT, diabetes education, endocrinology, or bariatric medicine; and MNT visit. We did not capture within-visit physician counseling.Key Results Of 16,713 outpatients with prediabetes, 20.4% received treatment, including metformin prescriptions (7.8%) and MNT referrals (11.3%), but only 7.4% of referred patients completed a MNT visit. The strongest predictor of treatment was the patient's PCP's treatment rate. Some PCPs never treated prediabetes, but two treated more than half of their patients; 62% had no patients complete a MNT visit. Being younger or female and having higher body mass index or HbA1c were also positively associated with treatment. Compared to white patients, black patients were more likely to receive MNT referral and less likely to receive metformin.Conclusions Almost 80% of patients with new prediabetes never received treatment, and those who did receive referrals had very poor visit completion. Treatment rates appear to reflect provider rather than patient preferences.