de Pablos Velasco Pedro, Franch Josep, Banegas Banegas José R, Fernández Anaya Silvia, Sicras Mainar Antoni, Díaz Cerezo Silvia
Departamento de Endocrinología, HUDN, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
Endocrinol Nutr. 2009 May;56(5):233-40. doi: 10.1016/S1575-0922(09)71406-8. Epub 2009 Jul 1.
To assess the degree of glycemic control and its associated factors in patients with diabetes mellitus (DM) attended by primary care teams in Spain.
A cross-sectional multicenter study was carried out using a structured questionnaire in diabetic patients consecutively attended from January to August 2007. Three groups were assessed: patients with type 1 diabetes mellitus (DM) and those with insulin-treated or non-insulin-treated type 2 DM. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Good glycemic control was defined as a glycated hemoglobin (HbA1c) value<or=7%. Sociodemographic characteristics, medical history, and clinical complications were collected. Factors associated with glycemic control were analyzed by means of multiple logistic regression analysis.
A total of 679 patients were included, classified into type 1 DM (11.5%), insulin-treated type 2 DM (26.2%) and noninsulin-treated type 2 DM (62.3%). The mean age was 65.2+/-13.7 years, 52.4% were women, 35.6% were obese, 86.0%, were dyslipidemic and 78.9% had hypertension. A total of 53.1% (CI: 49.3-56.9) showed good glycemic control (distribution among groups: 31.5%, 32.7% and 65.4%, respectively; p<0.001). Predictive factors for unsatisfactory control were age (odds ratio [OR]=0.984), time from diagnosis (OR=1.033) and insulin treatment (OR=4.054) (p<0.001). Only 3% [corrected] of the individuals achieved all the objectives recommended by the American Diabetes Association.
Glycemic control in diabetic patients can be improved. Only one in two patients with diabetes attended in primary care is properly controlled. The percentage of patients with satisfactory control in the insulin-treated group (types 1 and 2) was half that in the non-insulin-treated group.
评估西班牙基层医疗团队接诊的糖尿病患者的血糖控制程度及其相关因素。
采用结构化问卷对2007年1月至8月连续接诊的糖尿病患者进行多中心横断面研究。评估了三组患者：1型糖尿病患者以及接受胰岛素治疗或未接受胰岛素治疗的2型糖尿病患者。糖尿病的诊断依据美国糖尿病协会（ADA）标准确定。血糖控制良好定义为糖化血红蛋白（HbA1c）值≤7%。收集了社会人口学特征、病史和临床并发症。通过多元逻辑回归分析来分析与血糖控制相关的因素。
共纳入679例患者，分为1型糖尿病（11.5%）、胰岛素治疗的2型糖尿病（26.2%）和非胰岛素治疗的2型糖尿病（62.3%）。平均年龄为65.2±13.7岁，52.4%为女性，35.6%为肥胖患者，86.0%血脂异常，78.9%患有高血压。共有53.1%（CI：49.3 - 56.9）的患者血糖控制良好（各组分布分别为31.5%、32.7%和65.4%；p<0.001）。控制不佳的预测因素为年龄（比值比[OR]=0.984）、诊断后的时间（OR=1.033）和胰岛素治疗（OR=4.054）（p<0.001）。只有3%[校正后]的个体达到了美国糖尿病协会推荐的所有目标。
糖尿病患者的血糖控制可以得到改善。基层医疗中接诊的糖尿病患者只有二分之一得到了妥善控制。胰岛素治疗组（1型和2型）中控制满意的患者百分比是非胰岛素治疗组的一半。
