Direction de la stratégie des études et des statistiques (DSES), département des études sur les pathologies et les patients (DEPP), Caisse nationale d'assurance maladie des travailleurs salariés, 75986 Paris cedex 20, France.
Diabetes Metab. 2010 Apr;36(2):129-36. doi: 10.1016/j.diabet.2009.10.003. Epub 2010 Jan 29.
AIM: The objective of this study was to compare the management of diabetic and non-diabetic patients before, during and after hospitalization for myocardial infarction (MI). METHODS: Hospital admissions for MI in France from January to June 2006 were obtained from the national hospital-discharge database and merged with data on medications, 6 months before and after hospitalization of patients covered by the general health insurance scheme. Diabetic patients were identified by having at least two refunds for antidiabetic medications 6 months before the index hospitalization. Results comparing diabetic and non-diabetic patients were adjusted for age and gender. RESULTS: Of the 14,007 patients included in the study, 2545 were diabetic (18.2%). Before hospital admission, diabetic patients more frequently received secondary cardiovascular preventative medications (12.7% vs 4.2%; P<0.0001) and stent implants (4.2% vs 2.2%; P<0.0001) than did non-diabetic patients. During hospitalization and the following month, angioplasty (56.1% vs 61.7%; P=0.0001) and stent implantation (53.3% vs 59.3%; P<0.0001) were less frequently performed in diabetic patients and only coronary angiography was done in similar proportions of diabetic and non-diabetic patients (16.7% vs 15.2%). In addition, during the 6 months after hospitalization, diabetic vs non-diabetic patients had more admissions for cardiovascular reasons (36.9% vs 29.5%; P<0.0001) and were prescribed more secondary preventative medications (65.9% vs 61.7%; P<0.0001). They were also more frequently treated with insulin only (19.6% 6 months before vs 27.2% 6 months after) or oral antidiabetic drugs (14.6% vs 19.7%, respectively) than were non-diabetics. CONCLUSION: French diabetic patients subsequent to MI undergo fewer angioplasty procedures than do non-diabetic patients. After the acute stage, secondary preventative medications are used more often, with a marked rise in the use of insulin.
目的：本研究旨在比较糖尿病和非糖尿病患者在心肌梗死（MI）住院前、住院期间和住院后的管理情况。
方法：从法国 2006 年 1 月至 6 月的全国住院数据库中获取 MI 住院病例，并与参加全民健康保险计划的患者在住院前 6 个月的用药数据进行合并。通过至少有两次抗糖尿病药物退款的方式确定糖尿病患者。将比较糖尿病和非糖尿病患者的结果调整为年龄和性别。
结果：在纳入研究的 14007 例患者中，2545 例为糖尿病患者（18.2%）。在入院前，与非糖尿病患者相比，糖尿病患者更常接受二级心血管预防药物治疗（12.7%对 4.2%；P<0.0001）和支架植入术（4.2%对 2.2%；P<0.0001）。在住院期间和随后的一个月内，与非糖尿病患者相比，接受经皮冠状动脉介入治疗（56.1%对 61.7%；P=0.0001）和支架植入术（53.3%对 59.3%；P<0.0001）的比例较低，且只有冠状动脉造影术在糖尿病和非糖尿病患者中的比例相似（16.7%对 15.2%）。此外，在出院后的 6 个月内，与非糖尿病患者相比，糖尿病患者因心血管原因再次住院的比例更高（36.9%对 29.5%；P<0.0001），且接受二级预防药物治疗的比例更高（65.9%对 61.7%；P<0.0001）。此外，与非糖尿病患者相比，糖尿病患者在 6 个月前更常使用胰岛素（19.6%对 6 个月后 27.2%）或口服降糖药（14.6%对 19.7%）。
结论：法国 MI 后的糖尿病患者接受经皮冠状动脉介入治疗的次数少于非糖尿病患者。在急性期过后，更常使用二级预防药物，胰岛素的使用显著增加。
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