Changes in glycemic control from 1996 to 2006 among adults with type 2 diabetes: a longitudinal cohort study
Changes in glycemic control from 1996 to 2006 among adults with type 2 diabetes: a longitudinal cohort study
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DOI：
10.1186/1472-6963-10-158
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发表时间：
2010-06-09
影响因子：
2.8
通讯作者：
Grant, Richard W.
中科院分区：
文献类型：
--
作者：
Blumenthal, Karen J.;Larkin, Mary E.;Grant, Richard W.
背景：我们的目的是研究10年期间HbA1c和脂质水平的时间变化，并在纵向患者队列中确定代谢控制的预测因素。方法：我们确定了我院网络中所有在1996年和2006年测量过HbA1c的T2DM成年人（纵向队列）。对于2006年没有数据的患者，我们使用医院和社会保障记录来区分失访患者和1996年以后死亡的患者。我们比较了3个基线队列的特征（纵向、失f/u、死亡），并检查了纵向队列的代谢趋势。结果：1996年检测HbA1c的4944例患者中，1772例（36%）在2006年检测HbA1c， 1296例（26%）失访，1876例（38%）在2006年死亡。在纵向队列中，平均HbA1c在10年内下降了0.4 +/- 1.8%（从8.2% +/- 1.7%降至7.8% +/- 1.4%），平均总胆固醇下降了49.3 (+/- 46.5)mg/dL。在多变量模型中，HbA1c下降的独立预测因素包括年龄较大（OR为1.41 / 10年，95% CI: 1.3-1.6, p < 0.001）、基线HbA1c （OR为2.9 / 1%,2.6 - 3.2,p < 0.001）和说英语（OR为2.1,1.4-3.1,p < 0.001）。结论：尽管有额外10年的糖尿病，我们纵向队列中的患者在2006年的血糖和胆固醇控制比1996年更好。最大的改善发生在基线年最高水平的患者。
Background: Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort.Methods: We identified all adults within our hospital network with T2DM who had HbA1c's measured in both 1996 and 2006 (longitudinal cohort). For patients with no data in 2006, we used hospital and social security records to distinguish patients lost to follow-up from those who died after 1996. We compared characteristics of the 3 baseline cohorts (longitudinal, lost to f/u, died) and examined metabolic trends in the longitudinal cohort.Results: Of the 4944 patients with HbA1c measured in 1996, 1772 (36%) had an HbA1c measured in 2006, 1296 (26%) were lost to follow-up, and 1876 (38%) had died by 2006. In the longitudinal cohort, mean HbA1c decreased by 0.4 +/- 1.8% over the ten-year span (from 8.2% +/- 1.7% to 7.8% +/- 1.4%) and mean total cholesterol decreased by 49.3 (+/- 46.5) mg/dL. In a multivariate model, independent predictors of HbA1c decline included older age (OR 1.41 per decade, 95% CI: 1.3-1.6, p < 0.001), baseline HbA1c (OR 2.9 per 1% increment, 2.6 - 3.2, p < 0.001), and speaking English (OR 2.1, 1.4-3.1, p < 0.001).Conclusions: Despite having had diabetes for an additional 10 years, patients in our longitudinal cohort had better glycemic and cholesterol control in 2006 than 1996. Greatest improvements occurred in patients with the highest levels in the baseline year.