Ott P, Benke I, Stelzer J, Köhler C, Hanefeld M
Weisseritzel-Kliniken, Freital/Dippoldiswalde, Freital.
Dtsch Med Wochenschr. 2009 Feb;134(7):291-7. doi: 10.1055/s-0028-1123994. Epub 2009 Feb 5.
The efficacy of a multifactorial intervention with antihypertensive drugs, statins and acetylsalicylic acid was shown in the STENO 2 trial of diabetic patients with microalbuminuria. But how good is clinical practice in Germany? The DIG (Diabetes in Germany) study was an prospective survey, analysing the quality of risk factor control and treatment patterns of type 2 diabetics over 4 years between 2002 and 2007.
A total of 4020 type 2 diabetics (aged 35 - 80 years) were recruited by 238 physicians across Germany. Their medical history, risk factor profile and clinical data were recorded. The quality of control of diabetes, hypertension or hyperlipidemia and the use of aspirin were assessed in 2914 patients at baseline and after 3,7 years.
The mean HbA (1c) value was 6,98 % at baseline and 7,03 at the study end. 42,9 % at the beginning vs. 36,9 % at follow-up had HbA (1c) values above the target level of 6,5 %. Mean blood pressure was 139,3/80.0 compared with 137,3/79.9 mm Hg (p < 0,01), while 24,1 % and 27,0 %, respectively had values above the target level. Mean LDL-cholesterol levels were 3,23 mmol/l and 2,93 mmol/l, respectively, but only 23,2 % and 30,4 % of patients, respectively, reached target levels. There was a significant increase in the use of antihypertensive drugs, statins and acetylsalicylic acid over the four-year period.
Type 2 diabetics in Germany received an acceptable level of treatment for hyperglycaemia, but still more than 60 % of the patients have HbA (1c) values higher than 6,5 %. There are serious deficits in the management of hypertension, hypercholesterolemia and the use of aspirin. Because intensive, multifactorial care of type 2 diabetics leads to reduced rates of death and cardiovascular disorders, these results indicate that the early and meticulous implementation of current treatment guidelines remains a major challenge.
在糖尿病合并微量白蛋白尿患者的STENO 2试验中，已证实使用抗高血压药物、他汀类药物和乙酰水杨酸进行多因素干预的疗效。但德国的临床实践情况如何呢？DIG（德国糖尿病）研究是一项前瞻性调查，分析了2002年至2007年期间4年里2型糖尿病患者的危险因素控制质量和治疗模式。
德国各地的238名医生招募了总共4020名2型糖尿病患者（年龄在35 - 80岁之间）。记录了他们的病史、危险因素概况和临床数据。在2914名患者的基线期以及3.7年后，评估了糖尿病、高血压或高脂血症的控制质量以及阿司匹林的使用情况。
基线期平均糖化血红蛋白（HbA1c）值为6.98%，研究结束时为7.03%。基线期HbA1c值高于目标水平6.5%的患者占42.9%，随访时为36.9%。平均血压基线时为139.3/80.0，随访时为137.3/79.9毫米汞柱（p < 0.01），而血压高于目标水平的患者分别占24.1%和27.0%。平均低密度脂蛋白胆固醇水平分别为3.23毫摩尔/升和2.93毫摩尔/升，但达到目标水平的患者分别仅占23.2%和30.4%。在四年期间，抗高血压药物、他汀类药物和乙酰水杨酸的使用显著增加。
德国的2型糖尿病患者在高血糖治疗方面达到了可接受的水平，但仍有超过60%的患者HbA1c值高于6.5%。在高血压、高胆固醇血症管理以及阿司匹林使用方面存在严重不足。由于对2型糖尿病患者进行强化多因素护理可降低死亡率和心血管疾病发生率，这些结果表明，尽早并严格执行当前治疗指南仍是一项重大挑战。
