Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan.
J Epidemiol Community Health. 2014 Dec;68(12):1189-95. doi: 10.1136/jech-2014-204054. Epub 2014 Sep 3.
The impact of early initiation of diabetes care soon after the identification of hyperglycaemia rather than leaving diabetes untreated on changes in glycaemic control has not been fully clarified. We aimed to quantify the effect of initiating and continuing diabetes care compared with not starting management of diabetes on short-term changes in glycaemic control among the Japanese with newly screening-detected diabetes.
We retrospectively reviewed data from a nationwide claims database to assess histories of physician-diagnosed diabetes or hyperglycaemia, as well as the use of antidiabetic agents, blood testing for hyperglycaemia or dietary advice among individuals without a history of diabetes care. Changes in glycated haemoglobin (HbA1c) concentrations were evaluated using baseline data and data from a health examination during the following year.
Among 1393 individuals with newly screening-detected diabetes, 62% (n=864) did not initiate diabetes management during the follow-up period; 49.2% (n=425) of the untreated group had poor glycaemic control (HbA1c ≥7%) at the baseline examination. Only 38% (n=529) began diabetes management in medical settings. Individuals who remained untreated had a 1.87 (95% CI 1.38 to 2.52) or 1.63 (1.10 to 2.41) times higher risk of absolute increases in HbA1c ≥0.5% or ≥1%, respectively, compared with the treated patients, a difference that was significant. Making more frequent clinic visits especially after the first visit was dose-dependently associated with improved HbA1c levels compared with no diabetes management.
In comparison with a lack of management of diabetes, immediately initiating and continuing diabetes care after identification of hyperglycaemia in a screening setting would contribute to clinically meaningful, improved glycaemic control in the Japanese.
在发现高血糖后尽快开始糖尿病治疗，而不是不治疗糖尿病，这对血糖控制的变化影响尚未完全阐明。我们旨在量化与不开始管理糖尿病相比，启动和继续糖尿病治疗对新筛查发现的糖尿病日本患者短期血糖控制变化的影响。
我们回顾性地审查了来自全国性索赔数据库的数据，以评估无糖尿病治疗史的个体的医生诊断糖尿病或高血糖史，以及抗糖尿病药物的使用情况，高血糖血液检测或饮食建议。使用基线数据和下一年健康检查的数据评估糖化血红蛋白（HbA1c）浓度的变化。
在 1393 名新筛查发现的糖尿病患者中，62%（n=864）在随访期间未开始糖尿病管理；未治疗组中有 49.2%（n=425）在基线检查时血糖控制不佳（HbA1c≥7%）。只有 38%（n=529）在医疗机构开始进行糖尿病管理。与接受治疗的患者相比，未接受治疗的个体 HbA1c 增加≥0.5%或≥1%的绝对风险分别增加 1.87（95%CI 1.38 至 2.52）或 1.63（1.10 至 2.41），差异具有统计学意义。与不进行糖尿病管理相比，与治疗患者相比，更频繁地就诊（特别是在首次就诊后）与 HbA1c 水平的改善呈剂量依赖性相关。
与不治疗糖尿病相比，在筛查环境中发现高血糖后立即开始并持续进行糖尿病治疗，将有助于日本患者血糖控制得到有临床意义的改善。
