Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA.
Acad Emerg Med. 2012 Jun;19(6):650-5. doi: 10.1111/j.1553-2712.2012.01366.x. Epub 2012 May 25.
The objective was to determine if emergency department (ED) patients with diabetes mellitus (DM) who have primary care providers (PCPs) have better control of their DM than patients with no PCPs.
This was a prospective, cross-sectional, observation study at a large, adult, urban, academic ED with 85,000 annual visits. ED patients with a history of DM were eligible. Patients with severe systemic disease, diabetic ketoacidosis (DKA), sepsis, active steroid use, pregnancy, or cognitive impairment were excluded. Consenting patients had hemoglobin A1c (HgbA1c) analysis and completed a questionnaire regarding demographics, lifestyle, medication usage, educational level attained, and health care access, including whether or not they had PCPs. HgbA1c levels were compared between subjects with and without PCPs using medians with interquartile ranges (IQRs). A continuous plot was developed to demonstrate the proportion of patients without PCPs (PCP-) compared to those with PCPs (PCP+) at every level of %HgbA1c across the entire measured range. Multivariate logistic regression analysis was used to determine which clinical and demographic factors obtained from the questionnaire were associated with improved glycemic control (increased relative risk [RR] of having a %HgbA1c < 8%).
A total of 284 patients were screened; 227 were enrolled, had HgbA1c analysis performed, and had complete PCP, race, and sex information. Complete demographic data (insurance status, employment status, etc.) were available on 209 subjects. Sixty-four of the 227 patients (28.2%) denied having PCPs. Median HgbA1c was 7.7% (IQR = 6.5% to 9.68%) in PCP+ versus 8.9% (IQR = 6.8% to 11.3%) in PCP- patients (p = 0.01). Ninety-one of 163 (55.8%) PCP+ subjects had a median HgbA1c < 8% versus 25 of 64 (39.1%) in the PCP- group (p = 0.02). After adjusting for multiple clinical and demographic variables, having a PCP remained significantly associated with a median HgbA1c value less than 8% (RR = 1.43; p = 0.04).
Diabetes control was significantly better in patients with PCPs, even after adjusting for a number of potentially confounding social and demographic factors.
本研究旨在确定是否相较于无初级保健医生（PCP）的糖尿病（DM）患者，有 PCP 的急诊（ED）患者 DM 控制情况更好。
这是一项在一家大型成人城市学术 ED 进行的前瞻性、横断面、观察性研究，每年有 85000 次就诊。该研究纳入了有 DM 病史的 ED 患者。患有严重全身性疾病、糖尿病酮症酸中毒（DKA）、脓毒症、正在使用类固醇、妊娠或认知障碍的患者被排除在外。同意参与的患者进行了血红蛋白 A1c（HgbA1c）分析，并完成了一份关于人口统计学、生活方式、用药情况、所达到的教育水平以及医疗保健获取情况的调查问卷，包括他们是否有 PCP。使用中位数和四分位距（IQR）比较有和无 PCP 患者的 HgbA1c 水平。绘制连续图以显示整个测量范围内每个 HgbA1c 水平下无 PCP 患者（PCP-）与有 PCP 患者（PCP+）的比例。采用多变量逻辑回归分析确定问卷中获得的哪些临床和人口统计学因素与血糖控制改善相关（即 %HgbA1c＜8%的相对风险[RR]增加）。
共筛选了 284 名患者；227 名患者入组，进行了 HgbA1c 分析，且有完整的 PCP、种族和性别信息。209 名患者有完整的人口统计学数据（保险状况、就业状况等）。227 名患者中有 64 名（28.2%）否认有 PCP。PCP+患者的中位 HgbA1c 为 7.7%（IQR=6.5%至 9.68%），而 PCP-患者的中位 HgbA1c 为 8.9%（IQR=6.8%至 11.3%）（p=0.01）。在 163 名 PCP+患者中，91 名（55.8%）的中位 HgbA1c＜8%，而在 64 名 PCP-患者中，25 名（39.1%）的中位 HgbA1c＜8%（p=0.02）。在校正了多种临床和人口统计学变量后，有 PCP 与中位 HgbA1c 值＜8%仍显著相关（RR=1.43；p=0.04）。
即使在校正了一些潜在的混杂社会和人口统计学因素后，有 PCP 的患者的 DM 控制情况仍显著更好。
