STATINS AND ACE INHIBITORS IN ADULTS WITH DIABETES AND COMORBID CONDITIONS

他汀类药物和 ACE 抑制剂用于患有糖尿病和合并症的成人

• 批准号: 8015132
• 负责人: David E Grembowski
• 金额: $ 49.82万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015132
• 关键词: STATINS; ACE; INHIBITORS; ADULTS; DIABETES

DESCRIPTION (provided by applicant): Background and Significance. In 2003-2005 Group Health implemented pharmacy-based, system- wide outreach efforts that increased statin use in enrollees with diabetes from about 30 to 70%. Few studies have examined whether a large, population-level increase in statin use benefits macrovascular disease progression in adults with diabetes, and whether the benefits are similar for patients with different comorbid conditions. The issue is significant for comparative effectiveness research (CER) because most deaths among patients with diabetes are for cardiovascular disease, and reducing macrovascular disease progression through statin and ACE (angiotensin-converting enzyme) inhibitor treatments is an important element of diabetes care. Aims. For the population of adult enrollees with diabetes mellitus continuously enrolled in Group Health in 1997-2010, aims are to: 1) Describe the utilization of HMG-CoA reductase inhibitors (statins) and ACE inhibitors by comorbid group in 1998-2010; and 2) Following Group Health outreach, estimate the associations between statin and ACE inhibitor use and major vascular events and clinical quality of care in 2006-2010 by comorbid group. Population. 6,856 Group Health adult enrollees in Group Health Diabetes Registry with type 1 or 2 diabetes who were enrolled continuously from 1997-2006, survived to 2006, and will be followed through 2010. Co-morbid conditions are hypertension, coronary artery disease, congestive heart failure, and depression. Study Design. Population-based, retrospective longitudinal cohort. Data Sources. Group Health automated data bases. Measures. All-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, stroke, LDL- cholesterol, blood pressure, hemoglobin A1c (HbA1c), four co-morbid conditions, diabetes complications, Charlson co-morbidity index, drug adherence, diabetes treatment type, personal and plan characteristics, smoking, obesity (BMI), utilization of providers and Web-based health information. Analyses. For Aim 1, descriptive statistics and time series graphs will be produced to describe time of exposure to statins and ACE inhibitors for the 1998-2002 pre-outreach years, the 2003-2005 outreach years, and 2006-2010 post-outreach years. Bivariate statistical tests will be performed to determine whether enrollee personal and clinical characteristics are associated with exposure to statins and ACE inhibitors in the pre-outreach, outreach, and post-outreach years. In Aim 2, Cox proportional hazards and other regression models will estimate the associations between statin and ACE inhibitor use and major vascular events and clinical quality of care in 2006-2010 by co-morbid group. PUBLIC HEALTH RELEVANCE: In 2003-2005 Group Health implemented pharmacy-based, system-wide outreach efforts that increased statin use in enrollees with diabetes from about 30 to 70%. Few studies have examined whether a large, population-level increase in statin use has health benefits for adults with diabetes, and whether the benefits are similar for patients with different co-morbid conditions. The issue is significant for comparative effectiveness research (CER) because most deaths among patients with diabetes are for cardiovascular disease, and reducing macrovascular disease progression through statin and ACE inhibitor treatments is an important element of diabetes care.

描述（由申请人提供）：背景和意义。在2003-2005年，团体健康实施了基于药房的、全系统的外展工作，使糖尿病登记者中他汀类药物的使用从约30%增加到70%。很少有研究检查他汀类药物使用的大规模人群水平增加是否有利于糖尿病成人大血管疾病的进展，以及这种益处是否与不同共病患者相似。这一问题对于比较有效性研究（CER）具有重要意义，因为糖尿病患者的大多数死亡是心血管疾病，通过他汀类药物和ACE（血管紧张素转换酶）抑制剂治疗减少大血管疾病进展是糖尿病护理的重要因素。目标。对于1997-2010年连续入组Group Health的糖尿病成人入组人群，目的是：1）描述1998-2010年共病组HMG-CoA还原酶抑制剂（他汀类药物）和ACE抑制剂的使用情况;和2）在团体保健外展之后，估计2006-2010年共病组中他汀类药物和ACE抑制剂使用与主要血管事件和临床护理质量之间的相关性。人口6，856名患有1型或2型糖尿病的团体健康糖尿病登记处成人登记者，他们从1997年至2006年连续登记，存活至2006年，并将随访至2010年。合并症有高血压、冠状动脉疾病、充血性心力衰竭和抑郁症。研究设计.基于人群的回顾性纵向队列。数据源集团健康自动化数据库。措施全因死亡率、心血管死亡率、非致死性心肌梗死、卒中、LDL-胆固醇、血压、血红蛋白A1 c（HbA 1c）、四种共病状况、糖尿病并发症、Charlson共病指数、药物依从性、糖尿病治疗类型、个人和计划特征、吸烟、肥胖（BMI）、提供者利用率和基于Web的健康信息。分析。对于目标1，将生成描述性统计量和时间序列图，以描述1998-2002年推广前、2003-2005年推广年和2006-2010年推广后暴露于他汀类药物和ACE抑制剂的时间。将进行双变量统计检验，以确定入组者的个人和临床特征是否与外展前、外展和外展后几年他汀类药物和ACE抑制剂的暴露相关。在目标2中，考克斯比例风险和其他回归模型将按共病组估计2006-2010年他汀类药物和ACE抑制剂使用与主要血管事件和临床护理质量之间的相关性。 公共卫生关系：在2003-2005年，Group Health实施了以药房为基础的全系统外展工作，将糖尿病患者中他汀类药物的使用从约30%增加到70%。很少有研究探讨他汀类药物使用的大规模、人群水平的增加是否对糖尿病成年人的健康有益，以及这些益处对于患有不同共病的患者是否相似。这一问题对于比较有效性研究（CER）具有重要意义，因为糖尿病患者的大多数死亡是心血管疾病，通过他汀类药物和ACE抑制剂治疗减少大血管疾病进展是糖尿病护理的重要因素。