The Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
BMC Health Serv Res. 2010 Jun 9;10:158. doi: 10.1186/1472-6963-10-158.
Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort.
We identified all adults within our hospital network with T2DM who had HbA1c's measured in both 1996 and 2006 (longitudinal cohort). For patients with no data in 2006, we used hospital and social security records to distinguish patients lost to follow-up from those who died after 1996. We compared characteristics of the 3 baseline cohorts (longitudinal, lost to f/u, died) and examined metabolic trends in the longitudinal cohort.
Of the 4944 patients with HbA1c measured in 1996, 1772 (36%) had an HbA1c measured in 2006, 1296 (26%) were lost to follow-up, and 1876 (38%) had died by 2006. In the longitudinal cohort, mean HbA1c decreased by 0.4 +/- 1.8% over the ten-year span (from 8.2% +/- 1.7% to 7.8% +/- 1.4%) and mean total cholesterol decreased by 49.3 (+/- 46.5) mg/dL. In a multivariate model, independent predictors of HbA1c decline included older age (OR 1.41 per decade, 95% CI: 1.3-1.6, p < 0.001), baseline HbA1c (OR 2.9 per 1% increment, 2.6 - 3.2, p < 0.001), and speaking English (OR 2.1, 1.4-3.1, p < 0.001).
Despite having had diabetes for an additional 10 years, patients in our longitudinal cohort had better glycemic and cholesterol control in 2006 than 1996. Greatest improvements occurred in patients with the highest levels in the baseline year.
我们的目的是研究在 10 年内 HbA1c 和血脂水平的时间变化，并确定在纵向患者队列中代谢控制的预测因素。
我们确定了我们医院网络中所有在 1996 年和 2006 年都有 HbA1c 测量值的 2 型糖尿病患者（纵向队列）。对于 2006 年没有数据的患者，我们使用医院和社会保障记录将失访患者与 1996 年后死亡的患者区分开来。我们比较了三个基线队列（纵向、失访、死亡）的特征，并检查了纵向队列的代谢趋势。
在 4944 名 HbA1c 于 1996 年测量的患者中，1772 名（36%）在 2006 年测量了 HbA1c，1296 名（26%）失访，1876 名（38%）在 2006 年死亡。在纵向队列中，10 年内平均 HbA1c 下降 0.4±1.8%（从 8.2%±1.7%降至 7.8%±1.4%），总胆固醇平均下降 49.3（±46.5）mg/dL。在多变量模型中，HbA1c 下降的独立预测因素包括年龄较大（每 10 年增加 1.41，95%CI：1.3-1.6，p<0.001）、基线 HbA1c（每增加 1%增加 2.9，2.6-3.2，p<0.001）和讲英语（OR 2.1，1.4-3.1，p<0.001）。
尽管在纵向队列中患者的糖尿病病史又增加了 10 年，但他们在 2006 年的血糖和胆固醇控制情况优于 1996 年。基线年内水平最高的患者改善最大。
