Assessment and prevention of hypoglycaemia in primary care among U.S. Veterans: a mixed methods study.
Assessment and prevention of hypoglycaemia in primary care among U.S. Veterans: a mixed methods study.
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DOI：
10.1016/j.lana.2023.100641
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发表时间：
2023-12
期刊：
影响因子：
--
通讯作者：
Maruthur, Nisa M.
中科院分区：
文献类型：
--
作者：
Pilla, Scott J.;Meza, Kayla A.;Beach, Mary Catherine;Long, Judith A.;Gordon, Howard S.;Bates, Jeffrey T.;Washington, Donna L.;Bokhour, Barbara G.;Tuepker, Anais;Saha, Somnath;Maruthur, Nisa M.
关键词：
糖尿病治疗引起的低血糖导致发病率和生活质量降低，预防应在临床就诊时例行处理。这项混合方法研究通过分析美国五个退伍军人事务医疗中心的录音记录，评估初级保健提供者（pcp）如何评估和预防低血糖。两名研究人员独立编码访问对话，对低血糖病史、预期指导和根据糖尿病指南调整低血糖药物的讨论进行分类。共有242例患者（每例1次PCP就诊）和49例PCP。三分之二的患者接受胰岛素治疗，40%接受磺脲类药物治疗。242次就诊中有78次（32%）讨论了低血糖史。pcp在50次就诊（21%）中提供低血糖预期指导，重点是在禁食和携带葡萄糖标签时持有糖尿病药物；避免驾驶和胰高血糖素没有讨论。当患者报告有低血糖史时（15/51次就诊，29%）比患者报告无低血糖或未讨论低血糖史时（6/191次就诊，3%）降糖或调整致低血糖药物的频率更高（p < 0.001）。血红蛋白A1c （HbA1c）与糖尿病药物调整无关，只有5/12（42%）报告低血糖且HbA1c <7.0%的患者药物去强化或调整。pcp在三分之一的高危患者就诊中讨论了低血糖问题，并提供了有限的低血糖预期指导。在报告的HbA1c <7.0%的低血糖后，不常规使用降糖或调整降糖药物。需要进行常规低血糖评估和提供糖尿病自我管理教育，以实现与指南一致的低血糖预防。和(NIDDK)。
Hypoglycaemia from diabetes treatment causes morbidity and lower quality of life, and prevention should be routinely addressed in clinical visits. This mixed methods study evaluated how primary care providers (PCPs) assess for and prevent hypoglycaemia by analyzing audio-recorded visits from five Veterans Affairs medical centres in the US. Two investigators independently coded visit dialogue to classify discussions of hypoglycaemia history, anticipatory guidance, and adjustments to hypoglycaemia-causing medications according to diabetes guidelines. There were 242 patients (one PCP visit per patient) and 49 PCPs. Two thirds of patients were treated with insulin and 40% with sulfonylureas. Hypoglycaemia history was discussed in 78/242 visits (32%). PCPs provided hypoglycaemia anticipatory guidance in 50 visits (21%) that focused on holding diabetes medications while fasting and carrying glucose tabs; avoiding driving and glucagon were not discussed. Hypoglycaemia-causing medications were de-intensified or adjusted more often (p < 0.001) when the patient reported a history of hypoglycaemia (15/51 visits, 29%) than when the patient reported no hypoglycaemia or it was not discussed (6/191 visits, 3%). Haemoglobin A1c (HbA1c) was not associated with diabetes medication adjustment, and only 5/12 patients (42%) who reported hypoglycaemia with HbA1c <7.0% had medications de-intensified or adjusted. PCPs discussed hypoglycaemia in one-third of visits for at-risk patients and provided limited hypoglycaemia anticipatory guidance. De-intensifying or adjusting hypoglycaemia-causing medications did not occur routinely after reported hypoglycaemia with HbA1c <7.0%. Routine hypoglycaemia assessment and provision of diabetes self-management education are needed to achieve guideline-concordant hypoglycaemia prevention. and (NIDDK).
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.2337/cd21-0131
发表时间：
2022
期刊：
Clinical diabetes : a publication of the American Diabetes Association
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.2
作者：
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通讯作者：
Howell, Benjamin L.
影响因子：
13.2
作者：
Vlasschaert, Meghan E. O.;Bejaimal, Shayna A. D.;Garg, Amit X.
通讯作者：
Garg, Amit X.
影响因子：
2.8
作者：
So, Lawrence;Evans, Dewey;Quan, Hude
通讯作者：
Quan, Hude