Monnier L, Grimaldi A, Charbonnel B, Iannascoli F, Lery T, Garofano A, Childs M
Department of Metabolic Diseases, Lapeyronie Hospital, Montpellier, France.
Diabetes Metab. 2004 Feb;30(1):35-42. doi: 10.1016/s1262-3636(07)70087-3.
The Mediab study was conducted to estimate the medical care in French patients with type 2 diabetes mellitus managed by general practitioners on an ambulatory basis, but consIdered as requiring new treatment implementation.
Five thousand one hundred and fourty eight diabetic patients without any treatment or treated with lifestyle measures either alone or combined with an oral antIdiabetic agent given as monotherapy were included in a cross-sectional study that was conducted on a nationwIde basis by using the ORP (R) methodology. The 4088 patients in whom HbA1c was determined with a reliable method were further classified into 3 categories according to whether HbA1c was<=6.5% (group I, n=525), ranging between 6.6 and 8% (group II, n=1699) or > 8% (group III, n=1864).
A large proportion of patients (45.6%) exhibited HbA1c > 8%. Adherence to diet and regular physical activity were progressively decreasing while prevalence of diabetic complications was steadily increasing from group I to III, i.e. when diabetic control was worsening. The complications suffered from severe "underreporting". When complications were reported, the odds-ratio analysis showed that retinopathy is influenced by both the magnitude of glucose excess and the diabetes duration, while renal diseases and macroangiopathy depend mainly on diabetes duration. 38.1% of patients visited a diabetologist, but most of these patients were referred to the speciaList after the inclusion visit.
Despite the development of guIdelines, a large percentage of patients remains poorly-controlled. Future actions should be based on: (i) better collaboration between general practitioners and diabetologists (ii) better detection of complications that suffer from severe "underreporting", (iii) reinforcement of lifestyle recommendations and of pharmacological treatments by shifting from mono- to multi-drug therapy, at earlier stages of the disease.
开展Mediab研究以评估由全科医生在门诊管理但被认为需要实施新治疗方案的法国2型糖尿病患者的医疗护理情况。
5148例未接受任何治疗或仅采用生活方式干预措施治疗或联合口服降糖药单药治疗的糖尿病患者被纳入一项横断面研究，该研究采用ORP（R）方法在全国范围内开展。采用可靠方法测定糖化血红蛋白（HbA1c）的4088例患者根据HbA1c是否≤6.5%（I组，n = 525）、在6.6%至8%之间（II组，n = 1699）或> 8%（III组，n = 1864）进一步分为3类。
很大一部分患者（45.6%）的HbA1c> 8%。从I组到III组，即随着糖尿病控制情况恶化，饮食依从性和规律体育活动逐渐下降，而糖尿病并发症的患病率稳步上升。并发症存在严重的“报告不足”情况。当报告并发症时，比值比分析表明，视网膜病变受血糖超标程度和糖尿病病程的影响，而肾脏疾病和大血管病变主要取决于糖尿病病程。38.1%的患者看过糖尿病专科医生，但这些患者中的大多数是在纳入研究访视后才被转诊至专科医生处。
尽管制定了指南，但仍有很大比例的患者控制不佳。未来的行动应基于：（i）全科医生与糖尿病专科医生之间更好的协作；（ii）更好地检测存在严重“报告不足”的并发症；（iii）在疾病早期阶段通过从单药治疗转向多药治疗来加强生活方式建议和药物治疗。
