加拿大 2 型糖尿病患者心血管风险因素管理中的治疗差距。
Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada.
机构信息
Keenan Research Center, Li Ka Shing Knowledge Institute at St Michael's Hospital, University of Toronto, ON, Canada.
出版信息
Can J Cardiol. 2010 Jun-Jul;26(6):297-302. doi: 10.1016/s0828-282x(10)70393-7.
OBJECTIVES
To evaluate vascular protection treatment patterns and attainment of the 2003 Canadian Diabetes Association's recommended targets in ambulatory patients with type 2 diabetes.
METHODS
Between 2005 and 2006, 3002 outpatients with type 2 diabetes were enrolled by 229 primary health care settings across Canada. Baseline characteristics, therapeutic regimens and treatment success - defined as the achievement of a blood pressure (BP) of 13080 mmHg or lower, glycosylated hemoglobin (A1C) of 7% or lower, low-density lipoprotein cholesterol (LDL-C) lower than 2.5 mmolL and total cholesterolhigh-density lipoprotein cholesterol ratio lower than 4.0 - are reported.
RESULTS
Overall, 46% of individuals had a BP that was above the Canadian Diabetes Association's recommended target. Of these, 11% were untreated, 28% were receiving monotherapy, 38% were not receiving an angiotensin-converting enzyme inhibitor and 16% were not receiving either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Optimal A1C levels were achieved in 53% of patients. Of those who did not attain A1C targets, 3% were not on glucose- lowering pharmacotherapy and 27% were receiving monotherapy. A total of 74% of patients were treated with statins. Overall, 64% and 62%, respectively, met the target LDL-C and the target total cholesterolhigh-density lipoprotein cholesterol ratio. Statins were not prescribed to 43% of patients with LDL-C above target. Antiplatelet therapy was implemented in 81% of patients. In total, 21% achieved the combined targets for BP, A1C and LDL-C.
INTERPRETATION
A substantial proportion of patients did not achieve guideline-recommended targets and were not receiving evidence- based therapy for vascular protection two years after publication of the Canadian guidelines. More research is warranted, and novel and effective strategies must be tested and implemented to correct this ongoing treatment gap.
目的
评估 2 型糖尿病门诊患者的血管保护治疗模式，并达到 2003 年加拿大糖尿病协会的推荐目标。
方法
在 2005 年至 2006 年期间，加拿大的 229 个初级保健机构招募了 3002 名 2 型糖尿病门诊患者。报告了基线特征、治疗方案和治疗成功（定义为血压（BP）达到 130/80mmHg 或更低、糖化血红蛋白（A1C）达到 7%或更低、低密度脂蛋白胆固醇（LDL-C）低于 2.5mmol/L 和总胆固醇/高密度脂蛋白胆固醇比值低于 4.0）。
结果
总体而言，46%的个体血压高于加拿大糖尿病协会的推荐目标。其中，11%未接受治疗，28%接受单一疗法，38%未接受血管紧张素转换酶抑制剂治疗，16%未接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗。53%的患者达到了最佳的 A1C 水平。在未达到 A1C 目标的患者中，3%未接受降血糖药物治疗，27%接受单一疗法。共有 74%的患者接受了他汀类药物治疗。总体而言，分别有 64%和 62%的患者达到了 LDL-C 和总胆固醇/高密度脂蛋白胆固醇比值的目标。他汀类药物未开给 43%的 LDL-C 高于目标的患者。抗血小板治疗在 81%的患者中实施。总的来说，21%的患者同时达到了 BP、A1C 和 LDL-C 的联合目标。
解释
在加拿大指南发表两年后，相当一部分患者未达到指南推荐的目标，也未接受基于证据的血管保护治疗。需要进一步研究，并必须测试和实施新的有效策略来纠正这种持续存在的治疗差距。
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