Varma Swarna, Boyle Laura L, Varma Manu R, Piatt Gretchen A
Pittsburgh Endocrinology and Diabetes Associates, Bridgeville, PA 15017, USA.
Diabetes Res Clin Pract. 2008 Apr;80(1):89-95. doi: 10.1016/j.diabres.2007.10.029. Epub 2007 Dec 21.
Determine A1C, blood pressure (BP), and total cholesterol (TC) (Diabetes ABCs) control in a community-based endocrinology practice (CBEP) and compare levels to national averages. Additionally, determine patient factors associated with ABC control.
A retrospective chart audit of 395 consecutive patients seen for diabetes management was conducted for years 2000-2004 to examine levels of control of the ABCs. Multivariate models were used to determine patient factors associated with control.
Significantly more patients met the goal of A1C <7% in the CBEP compared to national estimates (CBEP: 47.1% vs. NHANES 1999-2000: 37%, p=0.003). Similar patterns were observed for BP (CBEP: 53.2% vs. NHANES 1999-2000: 35.8%, p<0.0001), TC (CBEP: 82% vs. NHANES 1999-2000: 48.2%, p<0.0001), and all three ABCs (CBEP: 22%, vs. NHANES 1999-2000: 7.3%, p<0.0001). The proportion of patients meeting all three ABC goals in the CBEP increased significantly over time (p<0.0001). Multivariate models demonstrated that patients not needing insulin (p<0.0001), and taking fewer BP (p<0.0001), and cholesterol-lowering medications (p<0.02) were significantly more likely to have ABCs in control.
Attainment of ABC goals is feasible in a CBEP and can be achieved at rates higher than national averages. Attention to factors that affect these goals is warranted.
确定社区内分泌实践（CBEP）中糖化血红蛋白（A1C）、血压（BP）和总胆固醇（TC）（糖尿病ABC指标）的控制情况，并将其水平与全国平均水平进行比较。此外，确定与ABC指标控制相关的患者因素。
对2000年至2004年期间因糖尿病管理而连续就诊的395例患者进行回顾性病历审查，以检查ABC指标的控制水平。使用多变量模型确定与控制相关的患者因素。
与全国估计值相比，CBEP中达到A1C<7%目标的患者显著更多（CBEP：47.1% vs. 1999 - 2000年美国国家健康与营养检查调查（NHANES）：37%，p = 0.003）。血压（CBEP：53.2% vs. 1999 - 2000年NHANES：35.8%，p<0.0001）、总胆固醇（CBEP：82% vs. 1999 - 2000年NHANES：48.2%，p<0.0001）以及所有三项ABC指标（CBEP：22%，vs. 1999 - 2000年NHANES：7.3%，p<0.0001）也观察到类似模式。CBEP中达到所有三项ABC目标的患者比例随时间显著增加（p<0.0001）。多变量模型表明，不需要胰岛素的患者（p<0.0001）、服用较少降压药（p<0.0001）和降脂药（p<0.02）的患者更有可能使ABC指标得到控制。
在CBEP中实现ABC目标是可行的，且达成率高于全国平均水平。有必要关注影响这些目标的因素。
