在欧洲，2 型糖尿病患者的心血管疾病和血糖控制情况：一项匹配队列研究。
Pre-existing cardiovascular diseases and glycemic control in patients with type 2 diabetes mellitus in Europe: a matched cohort study.
机构信息
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Cardiovasc Diabetol. 2010 Apr 21;9:15. doi: 10.1186/1475-2840-9-15.
BACKGROUND
Although there is a growing body of evidence showing that patients with type 2 diabetes mellitus (T2DM) have poor glycemic control in general, it is not clear whether T2DM patients with pre-existing cardiovascular diseases (CVD) are more or less likely to have good glycemic control than patients without pre-existing CVD. Our aim was to examine the degree of glycemic control among T2DM patients in Europe with and without pre-existing CVD.
METHODS
This is a matched cohort study based on a multi-center, observational study with retrospective medical chart reviews of T2DM patients in Spain, France, United Kingdom, Norway, Finland, Germany, and Poland. Included patients were aged >= 30 years at time of diagnosis of T2DM, had added a SU or a PPARgamma agonist to failing metformin monotherapy (index date) and had pre-existing CVD (cases). A control cohort with T2DM without pre-existing CVD was identified using 1:1 propensity score matching. With difference-in-difference approach, logistic and linear regression analyses were applied to identify differences in glycemic control by CVD during the follow up period, after controlling for baseline demographics, clinical information, and concurrent anti-hyperglycemic medication use.
RESULTS
The percentage of case patients with adequate glycemic control relative to control patients during the 1st, 2nd, 3rd, and 4th years after the index date was 19.9 vs. 26.5, 16.8 vs. 26.5, 18.8 vs. 28.3, and 16.8 vs. 23.5 respectively. Cases were significantly less likely to have adequate glycemic control (odds ratio: 0.62; 95% confidence interval: 0.46-0.82) than controls after adjusting for baseline differences, secular trend, and other potential confounding covariates.
CONCLUSIONS
T2DM patients with pre-existing CVD tended to have poorer glycemic control than those without pre-existing CVD, all other factors being equal. It suggests that clinicians may need to pay more attention to glycemic control among T2DM patients with CVD.
背景
尽管越来越多的证据表明，2 型糖尿病（T2DM）患者的血糖控制总体上较差，但尚不清楚是否患有预先存在的心血管疾病（CVD）的 T2DM 患者比没有预先存在 CVD 的患者更有可能实现良好的血糖控制。我们的目的是检查欧洲患有和不患有预先存在 CVD 的 T2DM 患者的血糖控制程度。
方法
这是一项基于多中心观察性研究的匹配队列研究，该研究通过回顾性病历审查，纳入了在西班牙、法国、英国、挪威、芬兰、德国和波兰接受治疗的 T2DM 患者。纳入的患者在诊断为 T2DM 时年龄>=30 岁，在二甲双胍单药治疗失败时（索引日期）添加了 SU 或 PPARγ激动剂，并且患有预先存在的 CVD（病例）。使用 1:1 倾向评分匹配，确定了没有预先存在 CVD 的 T2DM 对照队列。采用差异差异法，对血糖控制的差异进行逻辑和线性回归分析，在控制基线人口统计学、临床信息和同时使用抗高血糖药物的情况下，比较随访期间 CVD 对血糖控制的影响。
结果
在索引日期后的第 1、2、3 和 4 年，病例患者相对于对照患者的血糖控制达标率分别为 19.9%比 26.5%、16.8%比 26.5%、18.8%比 28.3%和 16.8%比 23.5%。在调整基线差异、趋势和其他潜在混杂因素后，病例患者的血糖控制达标率显著低于对照组（比值比：0.62；95%置信区间：0.46-0.82）。
结论
在其他因素相同的情况下，患有预先存在 CVD 的 T2DM 患者的血糖控制往往较差。这表明临床医生可能需要更加关注患有 CVD 的 T2DM 患者的血糖控制。
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