Sicras-Mainar Antoni, Navarro-Artieda Ruth, Rejas-Gutiérrez Javier, Fernández-de-Bobadilla Jaime, Frías-Garrido Xavier, Ruiz-Riera Rafael
Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain.
BMC Fam Pract. 2007 Oct 17;8:60. doi: 10.1186/1471-2296-8-60.
This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP).
This is a retrospective, observational study including patients > or =18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance.
A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7-80.5%) in PP and 20.9% (95% CI: 18.2-23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4-22.2%) in PP and 60.8% (95% CI: 57.6-64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00-1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03-1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06-1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22-1.89); p = 0.000] were covariates associated to the use of aspirin in PP.
Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved.
开展本研究以确定阿司匹林的使用情况，并根据一级预防（PP）或二级预防（SP）评估糖尿病患者治疗目标的达成情况。
这是一项回顾性观察性研究，纳入了在四个初级保健中心接受随访的18岁及以上糖尿病患者。测量指标包括人口统计学信息、阿司匹林和/或抗凝药物的使用情况、合并症、临床参数以及达到治疗目标（TT）的患者比例。采用描述性统计、卡方检验和逻辑回归模型进行显著性分析。
共分析了4140例患者，其中一级预防患者占79.1%（95%置信区间[CI]：77.7 - 80.5%），二级预防患者占20.9%（95%CI：18.2 - 23.7%）。平均年龄为64.1（13.8）岁，49.3%的患者为男性（一级预防：46.3，二级预防：60.7，p = 0.001）。一级预防中20.8%（95%CI：19.4 - 22.2%）的患者常规使用阿司匹林，二级预防中这一比例为60.8%（95%CI：57.6 - 64.0%）。血压达到治疗目标的患者比例为48.0%，胆固醇达到治疗目标的患者比例为59.8%。在一级预防中，阿司匹林的使用与年龄增加[比值比（OR）= 1.01（95%CI：1.00 - 1.02）；p = 0.011]、心血管危险因素[OR = 1.14（95%CI：1.03 - 1.27）；p = 0.013]、低密度脂蛋白胆固醇（LDL - C）[OR = 1.42（95%CI：1.06 - 1.88）；p = 0.017]以及更高的糖化血红蛋白[OR = 1.51（95%CI：1.22 - 1.89）；p = 0.000]相关，这些是与一级预防中阿司匹林使用相关的协变量。
在初级保健中，糖尿病患者一级预防中阿司匹林的使用不足。应改善治疗目标的达成情况。
