1型糖尿病青年患者的服务利用情况及血管并发症
Service usage and vascular complications in young adults with type 1 diabetes.
作者信息
James Steven, Perry Lin, Gallagher Robyn, Lowe Julia, Dunbabin Janet, McElduff Patrick, Acharya Shamasunder, Steinbeck Katharine
机构信息
University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia.
出版信息
BMC Endocr Disord. 2014 May 9;14:39. doi: 10.1186/1472-6823-14-39.
BACKGROUND
Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia.
METHODS
A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses.
RESULTS
A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction.
CONCLUSION
Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention.
背景
很少有研究调查1型糖尿病青年成人的医疗服务使用情况以及血管并发症的发生情况。作为糖尿病青年外展（YOuR - Diabetes）项目的一部分，本研究确定了澳大利亚新南威尔士州猎人新英格兰和下中北海岸地区16至30岁1型糖尿病青年成人队列中的医疗服务使用情况、血管并发症（高血压、视网膜病变和肾病）的患病率及预测因素。
方法
对2010年和2011年使用猎人新英格兰地方卫生区公共卫生服务的1型糖尿病青年成人病例记录进行横断面回顾性文献调查，通过门诊护理诊所记录、医院就诊记录及其他临床记录进行识别。提取服务使用细节、并发症筛查情况及血管并发症证据。使用线性和逻辑回归分析建立独立预测模型。
结果
共审查了707例患者；平均（标准差）年龄为23.0（3.7）岁，平均糖尿病病程为10.2（5.8，范围0.2 - 28.3）年；42.4%居住在/23.1%在非都市地区接受服务。常规预防性服务使用率低，非计划性就诊率高；两者均随年龄增长而恶化。并发症筛查水平较低。有记录显示，高血压尤其常见，在整个研究期间影响了48.4%的患者。糖尿病病程以及血糖控制是血管并发症的有力预测因素；高血压与肾功能障碍有关。
结论
研究结果表明，需要更好地了解年轻人在获取服务时的驱动因素和成果，以及如何重新配置或提供不同的服务，以更好地满足他们的需求并取得更好的结果。需要根据当前最佳实践指南进行定期筛查，因为这为早期并发症检测、治疗启动和二级预防提供了最大机会。
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