Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine of Chung Shan Medical University, Taichung, Taiwan.
School of Health Policy and Management, Institute of Medicine of Chung Shan Medical University, Taichung, Taiwan.
Am J Med. 2015 Sep;128(9):977-85.e3. doi: 10.1016/j.amjmed.2015.03.025. Epub 2015 Apr 20.
The Diabetes Shared Care Program (DSCP) is an integrated diabetes care model designed to increase the quality of diabetes care in Taiwan. The efficacy of this program is unknown. Therefore, we evaluated whether participating patients had reduced risks of cardiovascular events, including coronary heart disease, stroke, and all-cause mortality.
All 120,000 diabetes patients' data in this retrospective cohort study were obtained from Taiwan's National Health Insurance Research Database. DSCP participants received integrated care from a physician, diabetes educator, and dietitian. Otherwise, non-DSCP participants visited a physician without instruction from a diabetes educator or dietitian. We followed these patients until the first hospitalizations due to cardiovascular events. The Kaplan-Meier method was used to estimate the survival curves, and the Cox proportional hazards model was applied to determine the risk of cardiovascular events.
A total of 4458 participants and 4458 matched controls were enrolled in this study. Mean age of both participants and nonparticipants was 56 years. DSCP participants had significantly lower risks of cardiovascular events (hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.78-0.95), including stroke (HR 0.84; 95% CI, 0.73-0.98) and all-cause mortality (HR 0.78; 95% CI, 0.63-0.95), compared with nonparticipants. Older age, male, history of hypertension, chronic lung disease, and prescription for insulin secretagogues or insulin tended to have higher cardiovascular risks. Nevertheless, the following drugs reduced the cardiovascular risks: biguanides, alpha-glucosidase inhibitors, and thiazolidinediones.
Participation in the DSCP was associated with lower risks of cardiovascular events, stroke, and all-cause mortality.
糖尿病共照计划（DSCP）是一种综合的糖尿病护理模式，旨在提高台湾的糖尿病护理质量。该计划的疗效尚不清楚。因此，我们评估了参与患者是否降低了心血管事件的风险，包括冠心病、中风和全因死亡率。
本回顾性队列研究共纳入了来自台湾全民健康保险研究数据库的 120000 名糖尿病患者的数据。DSCP 参与者接受了医生、糖尿病教育者和营养师的综合护理。否则，非 DSCP 参与者仅接受医生的治疗，而没有接受糖尿病教育者或营养师的指导。我们对这些患者进行了随访，直到他们因心血管事件首次住院。Kaplan-Meier 法用于估计生存曲线，Cox 比例风险模型用于确定心血管事件的风险。
共有 4458 名参与者和 4458 名匹配的对照者纳入了本研究。参与者和非参与者的平均年龄均为 56 岁。与非参与者相比，DSCP 参与者的心血管事件风险显著降低（风险比[HR]0.86；95%置信区间[CI]，0.78-0.95），包括中风（HR 0.84；95% CI，0.73-0.98）和全因死亡率（HR 0.78；95% CI，0.63-0.95）。年龄较大、男性、有高血压病史、慢性肺部疾病病史，以及胰岛素分泌剂或胰岛素的处方，往往具有更高的心血管风险。然而，以下药物降低了心血管风险：二甲双胍、α-葡萄糖苷酶抑制剂和噻唑烷二酮类。
参与 DSCP 与较低的心血管事件、中风和全因死亡率风险相关。
