Beacco Maud, Vergès-Patois Bénédicte, Blonde Marie-Cécile, Crevisy Elodie, Habchi Marana, Bouillet Benjamin, Buffier Perrine, Petit Jean-Michel, Vergès Bruno
Service endocrinologie, diabétologie et maladies métaboliques, hôpital du Bocage, CHU, 21000 Dijon, France.
Service de réadaptation cardiaque, clinique SSR Les Rosiers, Dijon, France.
Arch Cardiovasc Dis. 2014 Jun-Jul;107(6-7):391-7. doi: 10.1016/j.acvd.2014.05.004. Epub 2014 Jun 26.
Although diabetes is associated with a high cardiovascular risk, very little information is available about diabetic patients enrolled in cardiac rehabilitation (CR).
To analyse the characteristics of diabetic patients and diabetes care in CR.
From the database of 700 patients enrolled in CR during a 29-month period, we analysed data from all patients with glucose metabolism disorders (n=105) and 210 matched normoglycaemic patients.
A total of 105 patients with glucose metabolism disorders (type 1 diabetes, n=5; type 2 diabetes, n=84; impaired fasting glucose, n=16) were enrolled in a CR programme (15% of whole population). Fifteen per cent of patients with type 2 diabetes and all patients with impaired fasting glucose were diagnosed during CR. These 105 patients were older and had a higher body mass index, a larger waist circumference, higher fasting blood glucose and triglyceride concentrations and lower low-density lipoprotein cholesterol concentrations than non-diabetic patients; they also had higher rates of hypertension (P=0.001) and dyslipidaemia (P=0.02). They were more frequently referred to CR for peripheral artery disease (P=0.001), coronary heart disease+peripheral artery disease (P=0.007) and primary prevention (P=0.009). The intervention of a diabetologist was needed for 42.6% of patients because of uncontrolled or newly diagnosed diabetes.
In the present study, we showed that (1) the proportion of patients with diabetes in CR is lower than expected, (2) many glucose metabolism disorders are diagnosed during CR, (3) patients with glucose metabolism disorders show a more severe cardiovascular risk profile than normoglycemic patients, and (4) the intervention of a diabetologist is needed during CR for many patients with diabetes.
尽管糖尿病与心血管疾病高风险相关，但关于参加心脏康复（CR）的糖尿病患者的信息却非常少。
分析参加心脏康复的糖尿病患者的特征及糖尿病护理情况。
从29个月期间参加心脏康复的700例患者的数据库中，我们分析了所有糖代谢紊乱患者（n = 105）和210例匹配的血糖正常患者的数据。
共有105例糖代谢紊乱患者（1型糖尿病，n = 5；2型糖尿病，n = 84；空腹血糖受损，n = 16）参加了心脏康复计划（占总人数的15%）。2型糖尿病患者的15%以及所有空腹血糖受损患者是在心脏康复期间被诊断出来的。与非糖尿病患者相比，这105例患者年龄更大，体重指数更高，腰围更大，空腹血糖和甘油三酯浓度更高，低密度脂蛋白胆固醇浓度更低；他们患高血压（P = 0.001）和血脂异常（P = 0.02）的比例也更高。他们因外周动脉疾病（P = 0.001）、冠心病+外周动脉疾病（P = 0.007）和一级预防（P = 0.009）而更频繁地被转诊至心脏康复。由于糖尿病未得到控制或为新诊断糖尿病，42.6%的患者需要糖尿病专科医生的干预。
在本研究中，我们表明：（1）参加心脏康复的糖尿病患者比例低于预期；（2）许多糖代谢紊乱是在心脏康复期间被诊断出来的；（3）糖代谢紊乱患者的心血管风险状况比血糖正常患者更严重；（4）许多糖尿病患者在心脏康复期间需要糖尿病专科医生的干预。
