Tomlin Andrew, Dovey Susan, Tilyard Murray
Royal New Zealand College of General Practitioners Dunedin Research Unit, Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin.
N Z Med J. 2007 Apr 13;120(1252):U2493.
To measure changes in the health status of 840 Type 1 and 9998 Type 2 diabetes patients who had completed three free annual diabetes reviews by December 2005.
We evaluated changes in clinical measures and differences in proportions of patients achieving guideline targets between the first and third reviews. Logistic regression analysis examined variables associated with an absolute decrease in HbA1c level of at least 1% from the first to the third review.
The proportion of patients achieving guideline targets for glycaemic control fell from 17.1% to 12.2% for Type 1 diabetes (p=0.004) and from 56.1% to 50.2% for Type 2 diabetes (p<0.001). There were significant improvements in mean albumin:creatinine ratio, total cholesterol, and high density lipoprotein levels in both diabetes cohorts and mean blood pressure and triglyceride levels in Type 2 patients. Adjusted odds of improved glycaemic control were higher for Type 2 diabetics treated with oral medication only (OR=4.27 (95%CI: 3.45-5.14)), insulin only (OR=7.10 [95%CI: 5.58-9.04]), and insulin and oral therapy (OR=10.05 [95%CI: 7.72-13.09]).
The introduction of a structured and systematic general practice review process aimed at improving diabetes care and patient outcomes resulted in significant improvements in mean blood pressure, cholesterol levels, and albumin:creatinine ratio. There was, however, no overall improvement in glycaemic control
对截至2005年12月已完成三次免费年度糖尿病复查的840例1型糖尿病患者和9998例2型糖尿病患者的健康状况变化进行测量。
我们评估了临床指标的变化以及首次复查和第三次复查之间达到指南目标的患者比例差异。逻辑回归分析检验了与糖化血红蛋白（HbA1c）水平从首次复查到第三次复查绝对下降至少1%相关的变量。
1型糖尿病患者达到血糖控制指南目标的比例从17.1%降至12.2%（p = 0.004），2型糖尿病患者从56.1%降至50.2%（p < 0.001）。两个糖尿病队列的平均白蛋白:肌酐比值、总胆固醇和高密度脂蛋白水平均有显著改善，2型患者的平均血压和甘油三酯水平也有改善。仅接受口服药物治疗的2型糖尿病患者（OR = 4.27 [95%CI: 3.45 - 5.14]）、仅接受胰岛素治疗的患者（OR = 7.10 [95%CI: 5.58 - 9.04]）以及接受胰岛素和口服治疗的患者（OR = 10.05 [95%CI: 7.72 - 13.09]）血糖控制改善的调整比值更高。
引入旨在改善糖尿病护理和患者预后的结构化、系统化的全科医疗复查流程，使平均血压、胆固醇水平和白蛋白:肌酐比值有显著改善。然而，血糖控制总体上没有改善。
