Institute of General Practice and Health Services Research, University Hospital of Zurich, Zurich, Switzerland.
Cardiovasc Diabetol. 2012 Jun 15;11:70. doi: 10.1186/1475-2840-11-70.
Although a variety of treatment guidelines for Type 2 diabetes patients are available, a majority of patients does not achieve recommended targets. We aimed to characterise Type 2 diabetes patients from Swiss primary care who miss HbA1c treatment goals and to reveal factors associated with the poorly controlled HbA1c level.
Cross-sectional study nested within the cluster randomised controlled Chronic Care for Diabetes study. Type 2 diabetes patients with at least one HbA1c measurement ≥ 7.0 % during the last year were recruited from Swiss primary care. Data assessment included diabetes specific and general clinical measures, treatment factors and patient reported outcomes.
326 Type 2 diabetes patients from 30 primary care practices with a mean age 67.1 ± 10.6 years participated in the study. The patients' findings for HbA1c were 7.7 ± 1.3 %, for systolic blood pressure 139.1 ± 17.6 mmHg, for diastolic blood pressure 80.9 ± 10.5 mmHg and for low density lipoprotein 2.7 ± 1.1. 93.3 % of the patients suffered from at least one comorbidity and were treated with 4.8 ± 2.1 different drugs. No determining factor was significantly related to HbA1c in the multiple analysis, but a significant clustering effect of GPs on HbA1c could be found.
Within our sample of patients with poorly controlled Type 2 diabetes, no "bullet points" could be pointed out which can be addressed easily by some kind of intervention. Especially within this subgroup of diabetes patients who would benefit the most from appropriate interventions to improve diabetes control, a complex interaction between diabetes control, comorbidities, GPs' treatment and patients' health behaviour seems to exist. So far this interaction is only poorly described and understood.
尽管有多种治疗 2 型糖尿病患者的指南，但大多数患者并未达到推荐的目标。我们旨在描述瑞士初级保健中错过糖化血红蛋白治疗目标的 2 型糖尿病患者，并揭示与控制不佳的糖化血红蛋白水平相关的因素。
在慢性糖尿病护理的集群随机对照研究中进行的横断面研究。从瑞士初级保健中招募了至少有一次糖化血红蛋白测量值≥7.0%的 2 型糖尿病患者。数据评估包括糖尿病特异性和一般临床指标、治疗因素和患者报告的结果。
30 家初级保健机构的 326 名 2 型糖尿病患者参加了这项研究，平均年龄为 67.1±10.6 岁。患者的糖化血红蛋白值为 7.7±1.3%，收缩压为 139.1±17.6mmHg，舒张压为 80.9±10.5mmHg，低密度脂蛋白为 2.7±1.1。93.3%的患者患有至少一种合并症，并接受了 4.8±2.1 种不同的药物治疗。在多因素分析中，没有确定的因素与糖化血红蛋白显著相关，但可以发现全科医生对糖化血红蛋白的聚类效应。
在我们控制不佳的 2 型糖尿病患者样本中，没有发现任何“要点”可以通过某种干预措施轻松解决。特别是在这群最需要适当干预措施来改善糖尿病控制的糖尿病患者中，糖尿病控制、合并症、全科医生的治疗和患者的健康行为之间似乎存在着复杂的相互作用。到目前为止，这种相互作用还描述和理解得很少。
