Vouri Scott Martin, Shaw Robert F, Waterbury Nancee V, Egge Jason A, Alexander Bruce
Texas Tech University Health Sciences Center School of Pharmacy, Dallas, TX 75216, USA.
J Manag Care Pharm. 2011 May;17(4):304-12. doi: 10.18553/jmcp.2011.17.4.304.
The "ABCs of Diabetes" are defined as hemoglobin A1c < 7.0%, blood pressure < 130/80 millimeters mercury (mm Hg), and lowdensity lipoprotein cholesterol (LDL-C) < 100 milligrams per deciliter (mg per dL). Assessments of 3-part goal attainment of A1c, blood pressure, and cholesterol have been reported using data from the National Health and Nutrition Examination Survey (NHANES) for several time periods (e.g., 1988-1994, 1999-2000, 1999-2002, and 2003-2004), Look Action for Health in Diabetes (Look AHEAD, 2001-2004), and community-based endocrinology practice (CBEP, 2000-2004). In 2002, an unpublished analysis of data from 2001-2002 at the Iowa City Veterans Affairs (ICVA) Medical Center found less than 50% of patients met each of the 3 individual goals. In the 5 years following the 2001-2002 assessment, the care for veterans with diabetes at the ICVA was enhanced to include (a) an increased number of diabetes classes and clinics, (b) implementation of the diabetes Care Coordination/Home Telehealth (CCHT) program, and (c) clinical reminders for diabetes performance measures that were added to the electronic medical record (EMR).
To (a) describe the prevalence of veterans meeting the ABC goals of diabetes in 1 VA medical center; (b) differentiate the proportion of diabetes patients who met the individual targets for A1c, blood pressure, and LDL-C and compare the results for 2008 through September 2009 with the earlier data from this facility (2001-2002); and (c) examine results reported previously in the literature for NHANES, Look AHEAD, and CBEP data sources.
Single-center, retrospective analysis of veterans at the ICVA for dates of service from January 1, 2008, through September 30, 2009, who (a) filled at least 1 prescription for an antidiabetic medication and (b) had each of the 3 biomarker values recorded in the EMR for A1c, blood pressure, and LDL-C after the antidiabetic prescription fill date.
Of the 5,426 (97.6% male) patients meeting inclusion criteria in 2008-2009, 17.3% (n = 936) achieved the 3-part ABC goal. In this managed care setting, achievement of the 3-part ABC goal surpassed the proportions reported in previous studies in NHANES data (5.2% in 1988-1994, 7.3% in 1999-2000, 7.0% in 1999-2002, 13.2% in 2003-2004), and 10.1% in Look AHEAD 2001-2004, but fell short of the 22.0% reported in CBEP 2000- 2004. When compared with the 2001-2002 results at ICVA, the proportion of patients achieving the individual A1c goal in 2008-2009 increased by 10.8 percentage points (from 43.2% to 54.0%), 12.6 percentage points for blood pressure (from 29.2% to 41.8%), and 17.1 percentage points for LDL-C (from 49.5% to 66.6%, P < 0.001) for the 3 individual comparisons.
The proportion of patients achieving each of the 3 goals for A1c, blood pressure, and LDL-C improved significantly in 2008-2009 compared with the 2001-2002 assessment in this medical center, following implementation of yearly clinical reminders for diabetes care, enhanced patient education, and other program changes that included home-based telephone monitoring with diabetes case management for some patients. Achievement of the 3-part ABC goal in 2008-2009 (17.3%) surpassed 5 assessments reported in the literature but was lower than the CBEP (2000- 2004) performance (22.0%).
糖尿病的“ABC指标”定义为糖化血红蛋白（A1c）<7.0%、血压<130/80毫米汞柱（mm Hg）以及低密度脂蛋白胆固醇（LDL-C）<100毫克/分升（mg/dL）。已有研究利用国家健康与营养检查调查（NHANES）多个时间段（如1988 - 1994年、1999 - 2000年、1999 - 2002年以及2003 - 2004年）的数据、糖尿病健康行动（Look AHEAD，2001 - 2004年）以及社区内分泌科实践（CBEP，2000 - 2004年），对A1c、血压和胆固醇三项指标达标情况进行了评估。2002年，对爱荷华市退伍军人事务（ICVA）医疗中心2001 - 2002年数据的一项未发表分析发现，不到50%的患者实现了这三项个体目标。在2001 - 2002年评估后的5年里，ICVA对糖尿病退伍军人的护理得到加强，包括（a）增加糖尿病课程和诊所数量，（b）实施糖尿病护理协调/家庭远程医疗（CCHT）项目，以及（c）在电子病历（EMR）中添加糖尿病绩效指标的临床提醒。
（a）描述一家退伍军人事务医疗中心达到糖尿病ABC目标的退伍军人患病率；（b）区分达到A1c、血压和LDL-C个体目标的糖尿病患者比例，并将2008年至2009年9月的结果与该机构早期数据（2001 - 2002年）进行比较；（c）研究先前文献中报道的NHANES、Look AHEAD和CBEP数据源的结果。
对ICVA在2008年1月1日至2009年9月30日服役的退伍军人进行单中心回顾性分析，这些退伍军人（a）至少开具过1次抗糖尿病药物处方，且（b）在开具抗糖尿病药物处方日期之后，EMR中记录了A1c、血压和LDL-C的三项生物标志物值。
在2008 - 2009年符合纳入标准的5426名患者（97.6%为男性）中，17.3%（n = 936）实现了ABC三项指标目标。在这种管理式医疗环境中，实现ABC三项指标目标的比例超过了先前NHANES数据研究中报告的比例（1988 - 1994年为5.2%，1999 - 2000年为7.3%，1999 - 2002年为7.0%，2003 - 2004年为13.2%）以及Look AHEAD 2001 - 2004年报告的10.1%，但低于CBEP 2000 - 2004年报告的22.0%。与ICVA 2001 - 2002年的结果相比，2008 - 2009年实现A1c个体目标的患者比例提高了10.8个百分点（从43.2%提高到54.0%），血压提高了12.6个百分点（从29.2%提高到41.8%），LDL-C提高了17.1个百分点（从49.5%提高到66.6%，P < 0.001），三项个体比较均如此。
与该医疗中心2001 - 2002年的评估相比，2008 - 2009年实现A1c、血压和LDL-C三项指标目标的患者比例显著提高，这是在实施糖尿病护理年度临床提醒、加强患者教育以及包括对部分患者进行家庭电话监测和糖尿病病例管理等其他项目改变之后。2008 - 2009年实现ABC三项指标目标的比例（17.3%）超过了文献中报道的5次评估，但低于CBEP（2000 - 2004年）的表现（22.0%）。
