Goderis Geert, Van Casteren Viviane, Declercq Etienne, Bossuyt Nathalie, Van Den Broeke Carine, Vanthomme Katrien, Moreels Sarah, Nobels Frank, Mathieu Chantal, Buntinx Frank
Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium.
Prim Care Diabetes. 2015 Oct;9(5):354-61. doi: 10.1016/j.pcd.2015.01.008. Epub 2015 Feb 21.
To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT=insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.
Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.
Comparing patients with (N=271) vs. without a CT (N=4424), we noted significant differences (p<0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98mg/dl), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p<0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p<0.05) after 2009 in the CT-group.
Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification.
分析护理轨迹（CT）是否与肠外降糖治疗（PHT = 胰岛素或GLP - 1类似物）、他汀类药物治疗或RAAS抑制的患病率增加相关。CT于2009年在比利时推出，针对需要或正在接受PHT的2型糖尿病（T2DM）患者。
基于97名全科医生的登记册进行回顾性研究。使用纵向逻辑回归比较了2006年以来有CT与无CT患者的治疗演变情况。
比较有CT的患者（N = 271）和无CT的患者（N = 4424），我们注意到糖尿病病程（10.1对7.3年）、糖化血红蛋白（7.5对6.9%）、低密度脂蛋白胆固醇（85对98mg/dl）、微血管并发症（26对16%）存在显著差异（p < 0.05）。此外，2006年，肠外治疗（OR 52.1）、他汀类药物（OR 4.1）和RAAS抑制（OR 9.6）的患病率显著更高（p < 0.001）。在2006年至2011年期间，两组中所有三种治疗的患病率均有所上升，但在CT组中，2009年后上升速度明显更快（p < 0.05）。
即使在该项目启动之前，纳入CT的患者与其他患者也有所不同，他们接受更强化的降糖和心血管治疗。然而，他们的糖化血红蛋白水平更高，并发症更多。纳入CT与额外的治疗强化相关。
