Valle T, Koivisto V A, Reunanen A, Kangas T, Rissanen A
Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Diabetes Care. 1999 Apr;22(4):575-9. doi: 10.2337/diacare.22.4.575.
To evaluate the quality of diabetes care at a national level in Finland, using level of glycemia as a determinant of success in treatment.
Physicians and diabetes nurses in 76 randomly selected clinics (59 primary care units and 17 hospitals) evenly covering the whole of Finland were asked to fill in a questionnaire asking for data based on the 1993 medical records of a random sample of 50 diabetic patients from each center (total n = 3,800). HbAlc was used as an index of glycemic control.
Information on 3,195 (84%) diabetic patients was received. HbAlc was measured in 67% of the patients in 1993. The mean HbAlc in the whole population was 8.6 +/- 1.9% (normal range 4-6%). Some 25% of patients had HbAlc < or = 7.3%, while 25% had HbAlc > or = 9.7%. The mean HbAlc was 8.8 +/- 1.9% in type 1 and 8.5 +/- 1.9% in type 2 diabetic patients. There was no sex difference in the HbAlc level in type 1 diabetic patients. However, male type 2 diabetic patients had better glycemic control than female patients (8.3 +/- 1.9 vs. 8.8 +/- 1.9%, P < 0.0001). The sex difference was independent of the type of therapy. The mean level of glycemic control was lowest among individuals with the shortest duration of diabetes. After 7-9 years after the diagnosis, there was no change in the mean level of glycemia.
Average glycemic control is poor in a majority of the diabetic patients in Finland. Better treatment strategies and methods should be used to improve glycemic control and to reduce long-term complications.
以血糖水平作为治疗成功的决定因素，在国家层面评估芬兰糖尿病护理的质量。
从芬兰全国随机选取76家诊所（59个初级保健单位和17家医院）的医生和糖尿病护士，要求他们填写一份问卷，问卷数据基于每个中心50例糖尿病患者的1993年医疗记录随机样本（总计n = 3800）。糖化血红蛋白（HbAlc）用作血糖控制指标。
收到了3195例（84%）糖尿病患者的信息。1993年，67%的患者测量了HbAlc。总体人群的平均HbAlc为8.6±1.9%（正常范围4 - 6%）。约25%的患者HbAlc≤7.3%，而25%的患者HbAlc≥9.7%。1型糖尿病患者的平均HbAlc为8.8±1.9%，2型糖尿病患者为8.5±1.9%。1型糖尿病患者的HbAlc水平无性别差异。然而，2型糖尿病男性患者的血糖控制优于女性患者（8.3±1.9对8.8±1.9%，P < 0.0001）。性别差异与治疗类型无关。糖尿病病程最短的个体血糖控制平均水平最低。诊断后7 - 9年，血糖平均水平无变化。
芬兰大多数糖尿病患者的平均血糖控制较差。应采用更好的治疗策略和方法来改善血糖控制并减少长期并发症。
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