Voorham Jaco, Haaijer-Ruskamp Flora M, van der Meer Klaas, de Zeeuw Dick, Wolffenbuttel Bruce H R, Hoogenberg Klaas, Denig Petra
Universitair Medisch Centrum Groningen, Afd. Klinische Farmacologie, Groningen, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A775.
To describe the quality of diabetes care at the primary care level using the risk factors HbA1c, blood pressure and LDL cholesterol.
Descriptive cohort study.
Using data collected electronically from 124 Dutch general practitioners from the province of Groningen (north Netherlands), we assessed the medication treatment level in relation to the level of control for HbA1c, blood pressure and LDL cholesterol (adequate, moderate or inadequate control). Furthermore, we assessed treatment adjustments between 2004 and 2007 in insufficiently controlled patients (HbA1c value, systolic blood pressure or LDL cholesterol concentration too high).
Data were available for 9646 patients in 2007. The averages for HbA1c, systolic blood pressure and LDL cholesterol were 6.9%, 142 mmHg and 2.3 mmol/l, respectively. Of the patients with an HbA1c > 8.5%, 16% were treated with one oral drug and 50% used insulin. In 27% of these patients, the treatment was subsequently modified. Between 2004 and 2007, a slight decrease in average HbA1c was observed, but no changes in treatment level. Systolic blood pressure was >or= 140 mmHg in 56% of the patients, 19% of whom were not using antihypertensive drugs. Between 2004 and 2007 the average systolic blood pressure decreased by 6 mmHg, whereas the treatment level scarcely increased. Of the 39% of patients whose LDL cholesterol level was >or= 2.5 mmol/l, 49% did not use statins. In 2004 there was an increase in the percentage of patients using statins.
The decreasing population averages of HbA1c, systolic blood pressure and LDL cholesterol values suggest an improvement in the quality of care. However, the relatively few therapy modifications observed in insufficiently controlled patients indicates that there is still room for improvement.
利用糖化血红蛋白（HbA1c）、血压和低密度脂蛋白胆固醇等危险因素描述初级保健层面的糖尿病护理质量。
描述性队列研究。
我们使用从荷兰格罗宁根省（荷兰北部）124名全科医生处电子收集的数据，评估了与HbA1c、血压和低密度脂蛋白胆固醇控制水平（充分、适度或不充分控制）相关的药物治疗水平。此外，我们评估了2004年至2007年期间控制不佳患者（HbA1c值、收缩压或低密度脂蛋白胆固醇浓度过高）的治疗调整情况。
2007年有9646名患者的数据可用。HbA1c、收缩压和低密度脂蛋白胆固醇的平均值分别为6.9%、142mmHg和2.3mmol/L。在HbA1c>8.5%的患者中，16%接受了一种口服药物治疗，50%使用了胰岛素。在这些患者中，27%的治疗随后进行了调整。2004年至2007年期间，观察到平均HbA1c略有下降，但治疗水平没有变化。56%的患者收缩压≥140mmHg，其中19%未使用抗高血压药物。2004年至2007年期间，平均收缩压下降了6mmHg，而治疗水平几乎没有提高。在低密度脂蛋白胆固醇水平≥2.5mmol/L的39%患者中，49%未使用他汀类药物。2004年使用他汀类药物的患者百分比有所增加。
HbA1c、收缩压和低密度脂蛋白胆固醇值的人群平均值下降表明护理质量有所改善。然而，在控制不佳的患者中观察到的治疗调整相对较少，这表明仍有改进空间。
