Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Duke University, Durham, NC.
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
Am J Med. 2014 Feb;127(2):145-51. doi: 10.1016/j.amjmed.2013.09.027. Epub 2013 Oct 15.
Group medical clinics may improve diabetes and hypertension control, but data about dyslipidemia are limited. We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension.
Prespecified secondary analysis of 239 veterans randomized to group medical clinics or usual care. Lipids were assessed at study baseline, midpoint, and end. We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol (LDL-C) goal attainment. An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms.
At baseline, mean total cholesterol was 169.7 mg/dL (SD 47.8), LDL-C 98.2 mg/dL (SD 41.7), and high-density lipoprotein cholesterol (HDL-C) 39.3 mg/dL (SD 13.0). Median baseline triglycerides were 131 mg/dL (interquartile range 122). By study end, mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL (P = .01) and 9.2 mg/dL (P = .02) lower than usual care, respectively; 76% of group medical clinic patients met goals for LDL-C, versus 61% of usual care patients (P = .02). Triglycerides and HDL-C remained similar between study arms. Treatment intensification occurred in 52% of group medical clinic patients, versus 37% of usual care patients between study baseline and end (P = .04). The mean statin dose was higher in group medical clinic patients at study midpoint and end.
Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension. This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care.
团体医疗诊所可能会改善糖尿病和高血压的控制情况，但有关血脂异常的数据有限。我们研究了团体医疗诊所对控制不佳的糖尿病和高血压患者血脂的影响。
对 239 名随机分配到团体医疗诊所或常规护理的退伍军人进行了预设的二次分析。在研究的基线、中点和终点评估了血脂。我们使用线性混合模型比较了手臂之间的血脂水平，并使用广义估计方程模型比较了低密度脂蛋白胆固醇（LDL-C）目标的实现情况。另外，在后验分析中，我们还研究了两个手臂中降低胆固醇药物的强化情况。
在基线时，平均总胆固醇为 169.7mg/dL（SD 47.8），LDL-C 为 98.2mg/dL（SD 41.7），高密度脂蛋白胆固醇（HDL-C）为 39.3mg/dL（SD 13.0）。中位数基线甘油三酯为 131mg/dL（四分位距 122）。在研究结束时，团体医疗诊所的平均总胆固醇和 LDL-C 分别比常规护理低 14.2mg/dL（P =.01）和 9.2mg/dL（P =.02）；76%的团体医疗诊所患者达到了 LDL-C 的目标，而常规护理患者为 61%（P =.02）。研究组之间的甘油三酯和 HDL-C 仍相似。在研究基线到结束期间，团体医疗诊所患者中有 52%的患者进行了治疗强化，而常规护理患者中有 37%（P =.04）。在研究中点和结束时，团体医疗诊所患者的他汀类药物剂量均值较高。
团体医疗诊所似乎可以改善糖尿病和高血压患者的血脂管理。这可能是由于团体医疗诊所相对于常规护理更加强化了降低胆固醇的药物治疗。
