Schütt M, Kern W, Zimmermann A, Busch P, Kerner W, Voll A, Wagner C, Kann P H, Dapp A, Holl R W
Department of Internal Medicine I, University of Lübeck, Germany.
Exp Clin Endocrinol Diabetes. 2010 Aug;118(8):490-5. doi: 10.1055/s-0030-1249024. Epub 2010 Mar 3.
Glycemic and body weight control are two outstanding goals in the treatment of patients with type 2 diabetes that often are not appropriately achieved. This observational study evaluates whether treatment by quality controlled diabetes centers generates an improvement in this regard and focuses on associations with different therapies. Data of 9.294 type 2 diabetic patients (mean age 66.9±11.6 years, mean diabetes duration 12.4±9.2 years) from 103 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database). Therapeutic concepts included lifestyle intervention (n=1.813), oral antidiabetics (OAD, n=1.536), insulin (n=4.504) and insulin plus OAD (n=1.441). HbA1c and body weight were compared before and after a stable therapeutical period of 1.07±0.3 years. Change in HbA1c (%): all patients 7.4±1.6-7.0±1.3, lifestyle intervention 7.5±1.9-6.9±1.5, OAD 6.7±1.1-6.5±1.0, insulin 7.6±1.6-7.2±1.4, insulin plus OAD 7.5±1.5-7.2±1.3; each p≤0.05. Change in body weight (kg): all patients +0.08±0.07, n. s.; lifestyle intervention -0.28±0.20, OAD -0.56±0.13, each p<0.05 [metfomin -0.77±0.21, sulfonylurea drugs -0.75±0.34, each p<0.05; glitazones +0.62±0.70, α-glucosidase inhibitors -0.22±0.76, each n. s.], insulin +0.27±0.10, insulin plus OAD +0.63±0.14, each n. s. In summary, lifestyle, metformin or sulfonylurea drug treatment resulted in HbA1c-values below 7.0% plus a significant weight reduction. Insulin treatment-associated concepts resulted in HbA1c-values slightly above 7.0% without body weight alterations. These "real life" data underline that a specialised and quality controlled diabetes care is able to achieve significant treatment results even in patients with disease progression and a high proportion of insulin therapies.
血糖和体重控制是2型糖尿病患者治疗中的两个突出目标,但往往难以得到恰当实现。这项观察性研究评估了由质量控制的糖尿病中心进行治疗在这方面是否能带来改善,并着重关注与不同治疗方法的关联。通过一个标准化、前瞻性、基于计算机的糖尿病护理与结局记录系统(DPV-Wiss数据库),对来自103个德国糖尿病中心的9294例2型糖尿病患者(平均年龄66.9±11.6岁,平均糖尿病病程12.4±9.2年)的数据进行了评估。治疗方案包括生活方式干预(n = 1813)、口服降糖药(OAD,n = 1536)、胰岛素(n = 4504)以及胰岛素联合OAD(n = 1441)。在1.07±0.3年的稳定治疗期前后,对糖化血红蛋白(HbA1c)和体重进行了比较。HbA1c的变化(%):所有患者从7.4±1.6降至7.0±1.3,生活方式干预组从7.5±1.9降至6.9±1.5,OAD组从6.7±1.1降至6.5±1.0,胰岛素组从7.6±1.6降至7.2±1.4,胰岛素联合OAD组从7.5±1.5降至7.2±1.3;每组p≤0.05。体重的变化(kg):所有患者为+0.08±0.07,无统计学意义;生活方式干预组为-0.28±0.20,OAD组为-0.56±0.13,每组p<0.05[二甲双胍-0.77±0.21,磺脲类药物-0.75±0.34,每组p<0.05;格列酮类+0.62±0.70,α-葡萄糖苷酶抑制剂-0.22±0.76,均无统计学意义],胰岛素组为+0.27±0.10,胰岛素联合OAD组为+0.63±0.14,均无统计学意义。总之,生活方式干预、二甲双胍或磺脲类药物治疗可使HbA1c值低于7.0%且体重显著减轻。胰岛素治疗相关方案导致HbA1c值略高于7.0%且体重无变化。这些“真实世界”的数据表明,即使对于疾病进展且胰岛素治疗比例较高的患者,专业且质量控制的糖尿病护理也能够取得显著的治疗效果。
Exp Clin Endocrinol Diabetes. 2010-8
Langenbecks Arch Surg. 2011-3-30