Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Diabetes Res Clin Pract. 2012 May;96(2):119-28. doi: 10.1016/j.diabres.2011.12.003. Epub 2012 Jan 17.
To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes.
Baseline demographic, health- and treatment-related measures were evaluated as predictors of one year glycaemic control defined separately as HbA(1c)≤ 7.5% and a continuous measure of HbA(1c) concentration, using multivariate regression models. Significant predictors were adjusted for objectively assessed medication adherence and BMI.
One-year HbA(1c) concentration was associated with baseline HbA(1c) (p<0.001), BMI (p=0.02), and inversely associated with age (p=0.007) and objectively assessed adherence. Adherent patients had one-year (adjusted) HbA(1c) concentration 0.65% (95% CI -1.04, -0.25; p=0.001) lower than nonadherent. Odds ratios (95% CI) of HbA(1c)≤ 7.5% for 10-year higher age were 1.63 (1.08, 2.45); for adherent compared to non-adherent patients 1.89 (0.84, 4.25); for patients receiving >5 compared to ≤ 5 medications 0.32 (0.13, 0.76); and for each 1% increment in baseline HbA(1c) 0.48 (0.31, 0.73).
The lower HbA(1c) achieved from greater adherence to glucose lowering treatment is comparable to that achieved with additional medication. Relationships between older age and better glycaemic control are not explained by better adherence, but may partly relate to lower BMI.
分析英国普通实践中血糖控制不佳的 2 型糖尿病患者的血糖控制预测因素，包括药物依从性和体重指数（BMI）。
使用多元回归模型，评估基线人口统计学、健康和治疗相关措施，将其作为一年血糖控制的预测因素，分别定义为 HbA1c≤7.5%和 HbA1c 浓度的连续测量值。使用客观评估的药物依从性和 BMI 调整显著预测因素。
一年的 HbA1c 浓度与基线 HbA1c（p<0.001）、BMI（p=0.02）相关，与年龄（p=0.007）和客观评估的依从性呈负相关。依从性好的患者一年的（调整后）HbA1c 浓度比不依从的患者低 0.65%（95%CI-1.04，-0.25；p=0.001）。年龄每增加 10 年，HbA1c≤7.5%的比值比（95%CI）为 1.63（1.08，2.45）；与不依从的患者相比，依从的患者为 1.89（0.84，4.25）；与服用>5 种药物相比，服用≤5 种药物的患者为 0.32（0.13，0.76）；与基线 HbA1c 每增加 1%，为 0.48（0.31，0.73）。
与增加药物治疗相比，更大程度地依从降血糖治疗可实现更低的 HbA1c。年龄较大与更好的血糖控制之间的关系不能用更好的依从性来解释，但可能部分与较低的 BMI 有关。
