Watts G F, Macleod A F, Benn J J, Slavin B M, Morris R W, Williams C D, Kearney E M, Lowy C, Sönksen P H
Department of Endocrinology and Chemical Pathology, UMDS, St Thomas' Hospital, London, UK.
Diabet Med. 1991 Jul;8(6):573-9. doi: 10.1111/j.1464-5491.1991.tb01654.x.
The within-clinic use of glycosylated haemoglobin (HbA1) and plasma fructosamine results in assessing blood glucose control and clinical management was compared in 1030 diabetic patients. The physician initially reviewed the patient with one randomly allocated measure (HbA1 or fructosamine) and completed a questionnaire concerning perception of blood glucose control, alteration to diet, alteration to medication, referral for diabetes education, and follow-up interval. The patient was then re-assessed using the second measure and the questionnaire repeated. Discordance rates for the study end-points, judged as binary outcomes, were: blood glucose control 15%; alteration to diet 7%; alteration to medication 9%; referral for education 3%; follow-up interval 4%. A significantly greater number of patients were rated as poorly controlled with HbA1 than with fructosamine (p less than 0.001) and were, in consequence, more frequently recommended alteration to diet and medication, referral for education and shorter follow-up interval; the rate of discordance for at least one of the management decisions was 16%. Multifactorial analysis showed that discordant management was dependent on the reviewing physician (p less than 0.001) and a history of cardiovascular disease (p less than 0.01); but neither type of diabetes, nor presence of nephropathy or variant haemoglobins, nor plasma glucose concentration, significantly influenced the likelihood of a discordance. Replacing HbA1 with fructosamine in the diabetic clinic may result in significant differences in the physician's perception of blood glucose control and in the management of patients.
在1030名糖尿病患者中，比较了糖化血红蛋白（HbA1）和血浆果糖胺在临床内用于评估血糖控制及临床管理的情况。医生最初使用一种随机分配的指标（HbA1或果糖胺）对患者进行检查，并完成一份关于血糖控制认知、饮食改变、药物调整、糖尿病教育转诊及随访间隔的问卷。然后使用另一种指标对患者进行重新评估，并重复填写问卷。将研究终点判断为二元结局时，其不一致率分别为：血糖控制15%；饮食改变7%；药物调整9%；教育转诊3%；随访间隔4%。与果糖胺相比，更多使用HbA1的患者被评定为血糖控制不佳（p<0.001），因此更常被建议改变饮食和药物、进行教育转诊以及缩短随访间隔；至少一项管理决策的不一致率为16%。多因素分析表明，不一致的管理取决于检查医生（p<0.001）和心血管疾病史（p<0.01）；但糖尿病类型、肾病或异常血红蛋白的存在以及血浆葡萄糖浓度均未显著影响不一致发生的可能性。在糖尿病诊所中用果糖胺取代HbA1可能会导致医生对血糖控制的认知以及患者管理方面出现显著差异。
