Calvert Melanie J, McManus Richard J, Freemantle Nick
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Fam Pract. 2007 Jun;24(3):224-9. doi: 10.1093/fampra/cmm008. Epub 2007 May 7.
Type 2 diabetes is common, largely managed in primary care and requires effective glycaemic control to reduce the risk of microvascular complications. Oral hypoglycaemic agents are typically the first pharmacological intervention used to improve glycaemic control.
To evaluate the management of people with type 2 diabetes with oral hypoglycaemic agents in primary care.
This retrospective cohort study included people with type 2 diabetes treated with oral agents drawn from 243 general practices in the UK over a 5-year study period from 1999 to 2003. Primary outcome measures were glycaemic monitoring and control on oral hypoglycaemic agents.
Of the 71,561 patients identified with prevalent type 2 diabetes, 20,922 received their first prescription for an oral hypoglycaemic agent during the study. Only 49% of patients had a recorded HbA(1c) within 6 months of starting therapy. Forty per cent of patients had poor glycaemic control (HbA(1c) > or = 7.5%) after starting a single hypoglycaemic agent. There was a statistically significant association between post-therapy HbA(1c) with pre-therapy HbA(1c), metformin dose, age and geodemographical classification. Greater reductions in HbA(1c) were observed in older patients, those with a high pre-treatment HbA(1c) and those from less-deprived areas. Patients remained on a single therapy for a median of 3.8 years. During the study, 7009 of those who started a single agent were prescribed a second agent. Of those with a recorded HbA(1c), 50% had poor glycaemic control (HbA(1c) > or = 7.5%) post-therapy.
Management of type 2 diabetes with oral hypoglycaemic agents appears to be suboptimal for many patients. Oral treatment is often not started until glycaemic control is poor, and many patients do not receive adequate monitoring or have poor glycaemic control following treatment with oral agents. Many patients with a high pre-treatment HbA(1c) are not controlled on a single oral agent even at high dose suggesting that earlier, more aggressive treatment in primary care is required.
2型糖尿病很常见，主要在初级医疗保健机构进行管理，需要有效的血糖控制以降低微血管并发症的风险。口服降糖药通常是用于改善血糖控制的首个药物干预措施。
评估初级医疗保健机构中使用口服降糖药治疗2型糖尿病患者的管理情况。
这项回顾性队列研究纳入了1999年至2003年5年研究期间从英国243家全科医疗诊所选取的接受口服药物治疗的2型糖尿病患者。主要结局指标是口服降糖药治疗期间的血糖监测和控制情况。
在确定患有2型糖尿病的71561例患者中，20922例在研究期间首次接受口服降糖药处方。只有49%的患者在开始治疗后6个月内有糖化血红蛋白（HbA1c）记录。40%的患者在开始使用单一降糖药后血糖控制不佳（HbA1c≥7.5%）。治疗后HbA1c与治疗前HbA1c、二甲双胍剂量、年龄和地理区域分类之间存在统计学显著关联。在老年患者、治疗前HbA1c水平高的患者以及来自贫困程度较低地区的患者中，观察到HbA1c降低幅度更大。患者单一治疗的中位时间为3.8年。在研究期间，开始单一药物治疗的患者中有7009例被处方了第二种药物。在有HbA1c记录的患者中，50%在治疗后血糖控制不佳（HbA1c≥7.5%）。
对于许多患者来说，使用口服降糖药治疗2型糖尿病的管理似乎并不理想。通常直到血糖控制不佳时才开始口服治疗，许多患者未得到充分监测，或者治疗后血糖控制不佳。许多治疗前HbA1c水平高的患者即使使用高剂量单一口服药物也无法得到控制，这表明在初级医疗保健中需要更早、更积极的治疗。
