Sloan Frank A, Bethel M Angelyn, Ruiz David, Shea Alisa M, Feinglos Mark N
Center for Health Policy and Management, Duke University, Durham, NC 27707, USA.
Arch Intern Med. 2008 Jan 28;168(2):192-9; discussion 199. doi: 10.1001/archinternmed.2007.35.
The prevalence of diabetes mellitus is growing worldwide. Consequently, there has been increased emphasis on primary and secondary prevention of diabetes. To our knowledge, whether there have been actual improvements in outcomes in the last decade or so has not been documented in a nationally representative sample.
We undertook this study to examine trends in rates of occurrence of diabetes and its complications in persons older than 65 years in the United States. National longitudinal analysis of Medicare claims and other Medicare program data for persons first diagnosed as having diabetes during 1994 (n=33 164), 1999 (n=31 722), or 2003 (n=40 058) were compared with 2 control groups of persons of approximately equal sample size who were not diagnosed as having diabetes, alternatively during 1994, 1999, or 2003 or for the entire period from 1994 to 1999 or from 1999 to 2004. The main outcome measures were death and complications of diabetes including cardiovascular, cerebrovascular, ophthalmic, renal, and lower extremity events.
The annual incidence of diabetes increased by 23% between 1994-1995 and 2003-2004, and prevalence increased by 62%. The mortality rate after diagnosis in persons having diagnosed diabetes decreased by 8.3% compared with that in the control groups. Complication rates among persons diagnosed as having diabetes generally increased or stayed the same compared with those in the control groups during 1994 to 2004 except for ophthalmic diseases associated with diabetes. Rates for some major complications were high; for example, the rate for congestive heart failure in the diabetes group during 1999 to 2004 was 475 per 1000 persons. In some cases, most notably renal events, including the most serious complications, there were increases in prevalence in both the diabetes and control groups.
The burden of financing and providing medical care for persons older than 65 in the United States having diagnosed diabetes is growing rapidly as a result of increased incidence and, especially, prevalence of diagnosed diabetes, decreased mortality, and overall lack of improvement in rates of complications in persons having diagnosed diabetes.
全球糖尿病患病率呈上升趋势。因此，对糖尿病一级和二级预防的重视程度日益增加。据我们所知，在过去十年左右的时间里，在具有全国代表性的样本中，糖尿病结局是否有实际改善尚无记录。
我们开展这项研究，以调查美国65岁以上人群中糖尿病及其并发症的发生率趋势。对1994年（n = 33164）、1999年（n = 31722）或2003年（n = 40058）首次被诊断为患有糖尿病的人群的医疗保险理赔数据和其他医疗保险项目数据进行全国纵向分析，并与两个样本量大致相等的未被诊断为患有糖尿病的对照组进行比较，对照组分别为1994年、1999年或2003年未被诊断为糖尿病的人群，或1994年至1999年或1999年至2004年整个期间未被诊断为糖尿病的人群。主要结局指标为死亡和糖尿病并发症，包括心血管、脑血管、眼科、肾脏和下肢事件。
1994 - 1995年至2003 - 2004年期间，糖尿病的年发病率上升了23%，患病率上升了62%。与对照组相比，已诊断糖尿病患者诊断后的死亡率下降了8.3%。1994年至2004年期间，与对照组相比，已诊断为患有糖尿病的人群的并发症发生率总体上升或保持不变，但与糖尿病相关的眼科疾病除外。一些主要并发症的发生率很高；例如，1999年至2004年期间，糖尿病组充血性心力衰竭的发生率为每1000人中有475例。在某些情况下，最显著的是肾脏事件，包括最严重的并发症，糖尿病组和对照组的患病率均有所上升。
由于糖尿病发病率尤其是患病率上升、死亡率下降以及已诊断糖尿病患者并发症发生率总体未改善，美国为65岁以上已诊断糖尿病患者提供医疗护理的资金负担正在迅速增加。
