年轻糖尿病患者心血管风险因素目标的实现。
Achievement of cardiovascular risk factor targets in young adults with diabetes mellitus.
机构信息
Department of Endocrinology, Mater Health Services, Mater Clinical School, The University of Queensland School of Medicine, South Brisbane, QLD, Australia.
出版信息
Diabetes Metab Syndr Obes. 2010 Nov 16;3:387-94. doi: 10.2147/DMSOTT.S13791.
BACKGROUND
Many patients with diabetes mellitus fail to achieve treatment targets recommended in recognized guidelines. Little data is available in this area relating to young adults.
OBJECTIVE
To assess whether treatment goals for glycosylated hemoglobin (HbA(1c)), blood pressure, lipid-lowering, and process outcomes for microvascular screening are being achieved in young adults with diabetes mellitus.
METHODS
A retrospective clinical record audit of 202 consecutive patients with type 1 and type 2 diabetes, aged predominantly 18-45 years, attending a specialist diabetes center in Brisbane, Australia, was conducted. Assessment was made as to whether goals for HbA(1c), blood pressure, lipid lowering, and microvascular screening were being achieved. Descriptive statistics and comparison of continuous variables were produced.
RESULTS
Mean (SD) HbA(1c) was 8.30% (±1.5) with no statistical difference between patients with type 1 and type 2 diabetes (P = 0.44). Sixteen percent of patients (12% type 1, 31% type 2) had an HbA(1c) of < 7%. Eighty-three percent of patients had blood pressure ≤130/80 mmHg. Sixteen percent of patients with type 1 and 37% with type 2 diabetes were achieving combined lipid targets. Only 34% and 9% of patients who had an indication (and no documented contraindication) for lipid-lowering and antiplatelet therapy, respectively, were prescribed such agents. There was a significant difference in achievement of macrovascular treatment targets in patients with type 1 and type 2 diabetes, but no difference in screening or treatment outcomes in microvascular disease. Patients below the age of 25 years were less likely to achieve macrovascular treatment targets.
CONCLUSION
A large number of young adult patients with diabetes mellitus do not achieve recognized treatment targets. There appears to be less emphasis placed on macrovascular risk factor targets compared with previous audits in older patients, in patients with type 1 diabetes compared with type 2 diabetes and in patients younger than 25 years.
背景
许多糖尿病患者未能达到公认指南中推荐的治疗目标。在这方面，很少有数据涉及年轻成年人。
目的
评估年轻成年人糖尿病患者的糖化血红蛋白（HbA1c）、血压、降脂以及微血管筛查的治疗目标是否得到实现。
方法
对澳大利亚布里斯班一家专科糖尿病中心的 202 例 1 型和 2 型糖尿病患者进行回顾性临床病历审计，这些患者年龄主要在 18-45 岁之间。评估是否达到 HbA1c、血压、降脂和微血管筛查的目标。结果以描述性统计和连续变量比较呈现。
结果
平均（SD）HbA1c 为 8.30%（±1.5），1 型和 2 型糖尿病患者之间无统计学差异（P = 0.44）。16%的患者（12%为 1 型，31%为 2 型）HbA1c<7%。83%的患者血压≤130/80mmHg。16%的 1 型患者和 37%的 2 型糖尿病患者达到了联合降脂目标。有降脂和抗血小板治疗指征（且无记录禁忌症）的患者中，分别只有 34%和 9%接受了此类药物治疗。1 型和 2 型糖尿病患者在实现大血管治疗目标方面存在显著差异，但在微血管疾病的筛查或治疗结果方面无差异。年龄低于 25 岁的患者更不可能实现大血管治疗目标。
结论
大量年轻成年糖尿病患者未达到公认的治疗目标。与之前对老年患者、1 型糖尿病患者与 2 型糖尿病患者以及年龄小于 25 岁的患者进行的审计相比，大血管危险因素目标的重视程度似乎较低。
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