Takahashi Paul Y, St Sauver Jennifer L, Finney Rutten Lila J, Jacobson Robert M, Jacobson Debra J, McGree Michaela E, Ebbert Jon O
Department of Internal Medicine, Division of Primary Care Internal Medicine, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
Diabetes Metab Syndr Obes. 2014 Dec 16;8:1-8. doi: 10.2147/DMSO.S71726. eCollection 2015.
Our objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM), and adverse health outcomes including emergency department (ED) visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU) stay, and mortality.
In 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL) cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome.
We identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6%) were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00-1.23), ED visits (HR 1.15; 95% CI 1.06-1.25), and mortality (HR 1.29; 95% CI 1.09-1.53) than diabetic patients with optimal control. No differences were observed in ICU stay or 30-day rehospitalization.
Diabetic patients without optimal control had higher risks of adverse health outcomes than those with optimal control. Patients with optimal control defined by the MCM were associated with decreased morbidity and mortality.
我们的目的是了解明尼苏达社区衡量标准（MCM）所定义的最佳糖尿病控制与不良健康结局之间的关系，这些不良健康结局包括急诊科就诊、住院、30天再住院、重症监护病房（ICU）住院时间以及死亡率。
2009年，我们对参保的患有糖尿病的员工和社区健康患者进行了一项回顾性队列研究。我们对患者进行随访，从2009年9月1日至2011年6月30日观察住院情况，至2014年1月5日观察死亡率。糖尿病的最佳控制定义为达到以下三项指标：低密度脂蛋白（LDL）胆固醇<100mg/mL、血压<140/90mmHg以及糖化血红蛋白<8%。利用电子病历，我们评估了住院情况、急诊科就诊、ICU住院时间、30天再住院情况以及死亡率。采用卡方检验或Wilcoxon秩和检验来比较达到最佳控制和未达到最佳控制的患者。我们使用Cox比例风险模型来估计最佳糖尿病状态与每种结局之间的关联。
我们确定了5731名参保的糖尿病患者；其中2842名（49.6%）属于最佳控制类别。经过调整后，我们观察到，与达到最佳控制的糖尿病患者相比，未达到最佳控制的患者住院风险更高（风险比[HR]1.11；95%置信区间[CI]1.00 - 1.23）、急诊科就诊风险更高（HR = 1.15；95% CI 1.06 - 1.25）以及死亡风险更高（HR = 1.29；95% CI 1.09 - 1.53）。在ICU住院时间或30天再住院方面未观察到差异。
未达到最佳控制的糖尿病患者比达到最佳控制的患者出现不良健康结局的风险更高。由MCM定义的达到最佳控制的患者与发病率和死亡率降低相关。
