美国糖尿病护理目标的实现，1999-2010 年。

Achievement of goals in U.S. diabetes care, 1999-2010.

机构信息

Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

出版信息

N Engl J Med. 2013 Apr 25;368(17):1613-24. doi: 10.1056/NEJMsa1213829.

DOI:10.1056/NEJMsa1213829

PMID:23614587

Abstract

BACKGROUND

Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care.

METHODS

We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999-2010 period.

RESULTS

From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1).

CONCLUSIONS

Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care.

摘要

背景

跟踪全国糖尿病护理进展有助于评估过去的努力，并确定护理方面的遗留差距。

方法

我们分析了 1999 年至 2010 年全国健康和营养检查调查以及行为风险因素监测系统中自我报告患有糖尿病的成年人的数据，以检查 1999 年至 2010 年间的危险因素控制、预防措施以及冠心病风险评分。

结果

从 1999 年到 2010 年，符合糖尿病护理推荐目标的调查参与者比例加权增加，血糖控制（糖化血红蛋白水平<7.0%）增加了 7.9 个百分点（95%置信区间 [CI]，0.8 至 15.0），个体化血糖目标增加了 9.4 个百分点（95%CI，3.0 至 15.8），血压（目标，<130/80mmHg）增加了 11.7 个百分点（95%CI，5.7 至 17.7），血脂（低密度脂蛋白胆固醇 [LDL] 目标水平，<100mg/dL[2.6mmol/L]）增加了 20.8 个百分点（95%CI，11.6 至 30.0）。虽然吸烟没有明显变化，但冠心病的 10 年发病风险降低了 2.8 至 3.7 个百分点。然而，仍有 33.4%至 48.7%的糖尿病患者未达到血糖控制、血压或 LDL 胆固醇水平的目标。只有 14.3%的人同时达到了这三个目标以及戒烟目标。每年进行眼部和牙科检查的建议的依从率没有变化，但每年进行血脂检测和足部检查的比例分别增加了 5.5 个百分点（95%CI，1.6 至 9.4）和 6.8 个百分点（95%CI，4.8 至 8.8）。接种流感疫苗和为 65 岁及以上的参与者接种肺炎球菌疫苗的比例分别上升了 4.5 个百分点（95%CI，0.8 至 8.2）和 6.9 个百分点（95%CI，3.4 至 10.4），每日血糖监测增加了 12.7 个百分点（95%CI，10.3 至 15.1）。