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新诊断的2型糖尿病是否按照指南进行治疗?波兰ARETAEUS1研究结果

Is newly diagnosed type 2 diabetes treated according to the guidelines? Results of the Polish ARETAEUS1 study.

作者信息

Bała Małgorzata M, Płaczkiewicz-Jankowska Ewa, Topór-Mądry Roman, Leśniak Wiktoria, Jaeschke Roman, Sieradzki Jacek, Grzeszczak Władysław, Banasiak Waldemar

机构信息

Polish Institute of Evidence Based Medicine, Kraków, Poland.

出版信息

Pol Arch Med Wewn. 2011 Jan-Feb;121(1-2):7-17.

Abstract

INTRODUCTION

There is a paucity of data on meeting treatment goals in patients with newly diagnosed type 2 diabetes (DM2).

OBJECTIVES

The aim of the study was to characterize Polish patients with newly diagnosed DM2, to assess management of hyperglycemia, and to estimate the proportion of patients achieving the criteria of disease control recommended by the national clinical practice guidelines published in 2008.

PATIENTS AND METHODS

ARETAEUS1 was a cross-sectional questionnaire-based study conducted in several regions of Poland in 2009 (January-April). It involved 1714 patients with DM2 of any age and sex, treated for less than 24 months, and recruited by randomly selected physicians.

RESULTS

Only 28.9% of patients with DM2 met the goal for glycated hemoglobin (HbA1c) control (<6.5%). In the total population, only 1.4% of all patients met all 3 goals (HbA1c, blood pressure, and lipid levels), 12.5%--2 goals, and 35.3%--only 1 goal; 50.7% did not meet any of the treatment goals. Achieving all of the treatment goals varied between the patient subgroups (in relation to the current diabetes treatment, age, sex, body mass index, and diabetes duration).

CONCLUSIONS

Most patients with newly diagnosed DM2 do not meet all their major treatment goals, which indicates relatively low adherence to the national guideline recommendations for diabetes control and primary cardiovascular prevention in DM2. Metformin seems to be underused and titration of other glucose lowering medications may be insufficiently target-driven. Assuming that adherence to the current clinical practice guidelines is beneficial for patients, we recommend that both practitioners and patients have increased awareness of these guidelines and of the ways to achieve and maintain treatment goals.

摘要

引言

关于新诊断2型糖尿病(DM2)患者达到治疗目标的数据较少。

目的

本研究旨在描述波兰新诊断的DM2患者特征,评估高血糖管理情况,并估计达到2008年发布的国家临床实践指南推荐的疾病控制标准的患者比例。

患者与方法

ARETAEUS1是一项基于问卷调查的横断面研究,于2009年1月至4月在波兰的几个地区开展。研究纳入了1714例年龄和性别不限、治疗时间少于24个月的DM2患者,由随机挑选的医生招募。

结果

仅28.9%的DM2患者达到糖化血红蛋白(HbA1c)控制目标(<6.5%)。在总体人群中,仅1.4%的患者达到所有3项治疗目标(HbA1c、血压和血脂水平),12.5%达到2项治疗目标,35.3%仅达到1项治疗目标;50.7%未达到任何治疗目标。不同患者亚组(根据当前糖尿病治疗方式、年龄、性别、体重指数和糖尿病病程)实现所有治疗目标的情况存在差异。

结论

大多数新诊断的DM2患者未达到所有主要治疗目标,这表明在DM2患者中,对国家糖尿病控制和心血管疾病一级预防指南建议的依从性相对较低。二甲双胍似乎未得到充分使用,其他降糖药物的滴定可能缺乏足够的目标导向。假设遵循当前临床实践指南对患者有益,我们建议从业者和患者都应提高对这些指南以及实现和维持治疗目标方法的认识。

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