在一个县接受糖尿病监测的患者11年间血糖控制情况的改善。
Improvement in glycemic control over 11 years in patients monitored for diabetes in one county.
作者信息
Jørgensen Lone G M, Petersen Per Hyltoft, Christensen Cramer, Eriksen Ebbe Wendel, Brandslund Ivan
机构信息
The Laboratory Center, Department of Clinical Biochemistry, Vejle County Hospital, Denmark.
出版信息
Clin Chem Lab Med. 2006;44(1):92-8. doi: 10.1515/CCLM.2006.018.
BACKGROUND
Hemoglobin A(1c) (HbA(1c)) has been used in controlled trials for the last 10 years but has never been evaluated in clinical practice as an effective parameter for clinical outcome. We investigated the trend for glycemic control over 11 years in one county of 350,000 citizens.
METHODS
We studied 226,382 HbA(1c-DCCT-aligned) from 39,455 patients in whom routine monitoring for diabetes was initiated in 1993, 1996, or 2001. The trend in glycemic control was investigated in groups by probit plots, and in individual patients by target plots.
RESULTS
From 1993 to 2001, the number of HbA(1c) measurements increased three-fold. The number of new monitoring series increased from 0.22% to 0.27% of the county population, and the number of patients monitored using HbA(1c) as a proxy for diabetes increased from 0.5% to 1.5%. A proportional reduction in high HbA(1c) concentrations of 5% was identified in the 1993 group, compared to 15% in the 1996 group, and 20% in the 2001 group. The percentage of patients with diabetic first HbA(1c) experiencing normalization increased from 8% to 30% for males and from 9% to 24% for females (1993-2001). The percentage of HbA(1c) concentrations that were not normalized decreased from 78% to 53% for males and from 83% to 59% for females (1993-2001). The median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The number of normal first HbA(1c) results in monitoring series increased from 7% to 17% for males and from 8% to 22% for females. Up to 10% of subjects developed diabetic concentrations during monitoring.
CONCLUSION
On average, patients with diabetic first HbA(1c) concentrations (> or =6.62%) showed an improvement in glycemic control from 5% in 1993 to 20% in 2001. High concentrations were easiest to reduce. In patients with originally diabetic HbA(1c) levels, 66% on average showed improved glycemic control in the 2001 series compared to 50% in the 1993 series. An average of 6% (1993) vs. 9% (2001) with originally normal HbA(1c) levels showed an upward trend inHbA(1c) levels. Median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The incidence of new cases was constant.
背景
过去10年中血红蛋白A1c（HbA1c）已用于对照试验，但从未在临床实践中作为临床结局的有效参数进行评估。我们调查了一个拥有35万居民的县11年间血糖控制的趋势。
方法
我们研究了1993年、1996年或2001年开始进行糖尿病常规监测的39455例患者的226382份HbA1c（与糖尿病控制与并发症试验[DCCT]校准）。通过概率单位图对各组的血糖控制趋势进行研究，通过目标图对个体患者的血糖控制趋势进行研究。
结果
1993年至2001年，HbA1c测量次数增加了两倍。新监测系列的数量从占该县人口的0.22%增至0.27%，使用HbA1c作为糖尿病替代指标进行监测的患者数量从0.5%增至1.5%。1993年组中高HbA1c浓度比例降低了5%，1996年组为15%，2001年组为20%。糖尿病初发HbA1c水平恢复正常的男性患者比例从8%增至30%，女性患者从9%增至24%（1993 - 2001年）。未恢复正常的HbA1c浓度比例男性从78%降至53%，女性从83%降至59%（1993 - 2001年）。监测开始时HbA1c的中位数从1993年的8.7%降至2001年的7.5%（p < 10⁻⁵）。监测系列中首次HbA1c结果正常的男性数量从7%增至17%，女性从8%增至22%。高达10%的受试者在监测期间出现糖尿病浓度。
结论
平均而言，糖尿病初发HbA1c浓度（≥6.62%）的患者血糖控制情况从1993年的5%改善至2001年的20%。高浓度最容易降低。与1993年系列中50%的患者相比，2001年系列中原本HbA1c水平为糖尿病范围的患者平均66%血糖控制得到改善。原本HbA1c水平正常的患者中，平均6%（1993年）对9%（2001年）的患者HbA1c水平呈上升趋势。监测开始时HbA1c的中位数从1993年的8.7%降至2001年的7.5%（p < 10⁻⁵）。新发病例的发生率保持稳定。
Zotero 插件