Bała Małgorzata M, Leśniak Wiktoria, Płaczkiewicz-Jankowska Ewa, Topór-Mądry Roman, Jaeschke Roman, Sieradzki Jacek, Grzeszczak Władysław, Banasiak Waldemar
Polish Institute of Evidence Based Medicine, Krakow, Poland.
Kardiol Pol. 2011;69(12):1249-57.
The practice guidelines of cardiological and diabetological societies emphasise that cardiovascular (CV) risk control in diabetic patients is especially important and should be stricter than in subjects without diabetes. There are little data on the frequency of meeting treatment goals in patients with newly diagnosed diabetes mellitus type 2 (DM2).
To characterise Polish patients with DM2 diagnosed within the previous two years and to assess if the treatment targets from the current (2008) guidelines of Diabetes Poland regarding control of CV risk factors are met.
ARETAEUS1 was a cross-sectional questionnaire-based study conducted in various regions of Poland in 2009 (January-April). It involved 1,714 patients of all ages and both genders, who had DM2 treated for less than 24 months. They were recruited by randomly selected physicians.
Total cholesterol treatment goal (< 4.5 mmol/L) was met in 22% of all patients, triglycerides treatment goal (< 1.7 mmol/L) in 44%, LDL cholesterol treatment goal (< 2.6 mmol/L) in 20% and HDL cholesterol treatment goal (> 1.0 mmol/L in men and > 1.3 mmol/L in women) in 55%. Only 13% of the overall population met the goal of blood pressure (BP) below 130/80 mm Hg. When a less restrictive BP control threshold (< 140/90 mm Hg) was applied, 48% of patients had their BP below the threshold. In the analysis of subgroups (patients with and without previous CV events; receiving 1-5 or not receiving antihypertensive drugs; receiving and not receiving statins and fibrates) we observed from 0% to 3.3% of patients meeting three (HbA1c, BP and cholesterol) treatment goals. The percentages of patients meeting two out of three treatment goals were between 8% and 33% in different subgroups. The percentages of patients meeting only one out of three treatment goals ranged from 27.8% to 46.7% or at least one - from 39% to 69%.
Most patients with newly diagnosed diabetes are not meeting their treatment goals regarding control of CV risk factors, which indicates relatively low adherence to national guideline recommendations for diabetes control and primary CV prevention in DM2. Difficulties in achieving CV treatment targets in the diabetic population indicate the need for a great deal of effort on the part of clinicians and patients. Practice guidelines developers should consider what treatment targets are achievable at a reasonable expense of effort.
心脏病学和糖尿病学学会的实践指南强调，糖尿病患者的心血管（CV）风险控制尤为重要，且应比非糖尿病患者更为严格。关于新诊断的2型糖尿病（DM2）患者达到治疗目标的频率的数据较少。
描述波兰过去两年内诊断为DM2的患者特征，并评估是否达到了波兰糖尿病学会当前（2008年）指南中关于控制CV危险因素的治疗目标。
ARETAEUS1是一项基于问卷调查的横断面研究，于2009年1月至4月在波兰各地区开展。研究纳入了1714例年龄和性别各异、DM2治疗时间少于24个月的患者。他们由随机选择的医生招募。
所有患者中，22%达到总胆固醇治疗目标（<4.5 mmol/L），44%达到甘油三酯治疗目标（<1.7 mmol/L），20%达到低密度脂蛋白胆固醇治疗目标（<2.6 mmol/L），55%达到高密度脂蛋白胆固醇治疗目标（男性>1.0 mmol/L，女性>1.3 mmol/L）。总体人群中只有13%达到血压（BP）低于130/80 mmHg的目标。当采用限制较宽松的血压控制阈值（<140/90 mmHg）时，48%的患者血压低于该阈值。在亚组分析（有或无既往CV事件的患者；接受1 - 5种或未接受抗高血压药物的患者；接受和未接受他汀类药物及贝特类药物的患者）中，我们观察到达到三项（糖化血红蛋白、血压和胆固醇）治疗目标的患者比例为0%至3.3%。在不同亚组中，达到三项治疗目标中两项的患者比例在8%至33%之间。达到三项治疗目标中仅一项的患者比例在27.8%至46.7%之间，或至少达到一项的患者比例在39%至69%之间。
大多数新诊断的糖尿病患者未达到CV危险因素控制的治疗目标，这表明在DM2中对国家糖尿病控制和原发性CV预防指南建议的依从性相对较低。糖尿病患者难以实现CV治疗目标表明临床医生和患者都需要付出巨大努力。实践指南制定者应考虑在合理的努力成本下可实现哪些治疗目标。
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