Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes.
Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes.
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DOI：
10.1161/jaha.116.003566
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发表时间：
2016-08-10
影响因子：
5.4
通讯作者：
Skinner JS
中科院分区：
文献类型：
--
作者：
Goodney PP;Newhall KA;Bekelis K;Gottlieb D;Comi R;Chaudrain S;Faerber AE;Mackenzie TA;Skinner JS
建议糖尿病患者每年进行糖化血红蛋白检测。然而，目前尚不清楚糖尿病患者接受糖化血红蛋白检测的一致性如何，或者检测一致性是否与不良心血管结局相关。我们确定了 1 574 415 名 65 岁以上患有糖尿病的医疗保险患者（2002 年至 2012 年）。我们对每位患者进行了至少 3 年的随访，以确定他们在糖化血红蛋白检测中的一致性，使用 3 个类别：低（在 3 年中的 0 或 1 年内进行检测）、中（在 3 年中的 2 年内进行检测）和高（在所有患者中进行检测） 3 年）。在未加权和逆倾向加权队列中，我们检查了测试一致性与主要不良心血管事件（定义为死亡、心肌梗死、中风、截肢或腿部血运重建的需要）之间的关联。总体而言，70.2%的患者接受了高一致性测试，17.6%的患者接受了中一致性测试，12.2%的患者接受了低一致性测试。与高一致性测试相比，在未加权分析（风险比[HR]=1.21；95% CI，1.20-1.23；P<0.001）、反向倾向加权分析（HR=1.16；95% CI，1.15-1.17；P<0.001）中，低一致性测试与较高的不良心血管事件或死亡风险相关。加权分析仅限于每年至少就诊 4 次的患者（HR=1.15；95% CI，1.15–1.16；P<0.001）。在使用所有年份作为暴露量的分析中，不太一致的测试与每种心血管结局的较差结果相关。在这一医疗保险糖尿病患者观察队列中，持续进行年度糖化血红蛋白检测与不良心血管结局的减少相关。
Annual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes. We identified 1 574 415 Medicare patients (2002–2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 years). In unweighted and inverse propensity‐weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high‐consistency testing, 17.6% of patients received medium‐consistency testing, and 12.2% of patients received low‐consistency testing. When compared to high‐consistency testing, low‐consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20–1.23; P<0.001), inverse propensity‐weighted analyses (HR=1.16; 95% CI, 1.15–1.17; P<0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15–1.16; P<0.001). Less‐consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure. Consistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Medicare patients of diabetes mellitus.