美国糖尿病的连续护理：可视化差距。

A cascade of care for diabetes in the United States: visualizing the gaps.

出版信息

Ann Intern Med. 2014 Nov 18;161(10):681-9. doi: 10.7326/M14-0019.

DOI:10.7326/M14-0019

PMID:25402511

Abstract

BACKGROUND

A "cascade-of-care" concept helped to address implementation gaps in HIV care.

OBJECTIVE

To develop a similar cascade for U.S. diabetes care to visualize gaps in awareness of diagnosis, engagement, and treatment.

DESIGN

Nationally representative cross-sectional surveys.

SETTING

2007 to 2012 NHANES (National Health and Nutrition Examination Surveys).

PARTICIPANTS

Nonpregnant civilians aged 18 years or older.

MEASUREMENTS

Standardized data collection and laboratory procedures. Diabetes care was benchmarked against recent diabetes and cardiovascular risk reduction guidelines.

RESULTS

In 2012, an estimated 28.4 million (11.8%) U.S. adults had diabetes, of whom 20.5 million (72.2%) were aware of their diagnosis. Among diagnosed adults, 95.3% had a usual care provider and 91.7% made 2 or more visits in the past year. In contrast, among undiagnosed adults, 84.5% had a usual care provider and 66.5% reported 2 or more visits in the past year. Among diagnosed adults, 63.7%, 65.5%, 56.6%, and 80.6% met individualized hemoglobin A1c, blood pressure (BP <140/80 mmHg), lipid (low-density lipoprotein [LDL] cholesterol <2.6 mmol/L [<100 mg/dL]), and nonsmoking goals, respectively; 26.7% met combined ABC (hemoglobin A1c, BP, and LDL cholesterol) targets, and 21.3% met combined ABC targets and did not smoke. Among undiagnosed adults, 77.0%, 57.9%, 36.0%, and 77.9% met hemoglobin A1c, BP, lipid, and nonsmoking goals, respectively; 22.1% met combined ABC targets; and 18.8% met combined ABC targets and were nonsmokers.

LIMITATION

Institutionalized and noncivilian persons are not surveyed in NHANES.

CONCLUSION

Three of 10 adults with diabetes remain undiagnosed, which may be related to less access to care. Compared with diagnosed adults, undiagnosed adults have less elevated hemoglobin A1c levels, less lipid treatment and worse control, and similarly poor BP and combined ABC control regardless of smoking status. Addressing these care gaps in both groups would prevent long-term complications.

PRIMARY FUNDING SOURCE

None.

摘要

背景

“关怀级联”概念有助于解决艾滋病毒护理方面的实施差距问题。

目的

为美国糖尿病护理开发类似的级联，以直观了解诊断、参与和治疗方面的认识差距。

设计

全国代表性的横断面调查。

设置

2007 年至 2012 年 NHANES（国家健康和营养检查调查）。

参与者

18 岁或以上的非孕妇平民。

测量方法

标准化数据收集和实验室程序。根据最近的糖尿病和心血管风险降低指南来衡量糖尿病护理。

结果

2012 年，估计有 2840 万（11.8%）美国成年人患有糖尿病，其中 2050 万人（72.2%）知晓自己的诊断。在确诊的成年人中，95.3%有常规护理提供者，91.7%在过去一年中有 2 次或更多次就诊。相比之下，在未确诊的成年人中，84.5%有常规护理提供者，66.5%报告过去一年中有 2 次或更多次就诊。在确诊的成年人中，分别有 63.7%、65.5%、56.6%和 80.6%符合个性化的血红蛋白 A1c、血压（<140/80 mmHg）、血脂（低密度脂蛋白胆固醇 [<100mg/dL]）和不吸烟目标；分别有 26.7%、21.3%符合联合 ABC（血红蛋白 A1c、血压和 LDL 胆固醇）目标和不吸烟目标。在未确诊的成年人中，分别有 77.0%、57.9%、36.0%和 77.9%符合血红蛋白 A1c、血压、血脂和不吸烟目标；分别有 22.1%、18.8%符合联合 ABC 目标和不吸烟目标。