基层医疗诊所和专科诊所对美国糖尿病协会糖尿病护理指南的遵循情况比较。

Comparison of the adherence to the american diabetes association guidelines of diabetes care in primary care and subspecialty clinics.

作者信息

Rao Deepthi Takkalapelli, Sunio Lily Kristine, Lo Yun-Jia, Gossain Ved Vyas

机构信息

Division of Endocrinology, Michigan State University, 788 Service Road, Room B319, East Lansing, MI 48824-7016 USA.

Division of Endocrinology, Michigan State University, 788 Service Road, Room B319, East Lansing, MI 48824-7016 USA ; Present address: Division of Endocrinology, Michigan State University, 832 East Colfax Ave, Mishawaka, IN 46545 USA.

出版信息

J Diabetes Metab Disord. 2015 Apr 24;14:35. doi: 10.1186/s40200-015-0158-x. eCollection 2015.

DOI:10.1186/s40200-015-0158-x

PMID:25932457

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4415252/

Abstract

BACKGROUND

Diabetes mellitus is a major public health problem with significant morbidity and mortality. Evidence based guidelines have been proposed to reduce the micro and macrovascular complications, but studies have shown that these goals are not being met. We sought to compare the adherence to the American Diabetes Association guidelines for measurement and control of glycohemoglobin (A1c), blood pressure (BP), lipids (LDL) and microalbuminuria (MA) by subspecialty and primary care clinics in an academic medical center.

METHODS

390 random charts of patients with diabetes from Family Practice (FP), Internal Medicine (IM) and Diabetes (DM) clinics at Michigan State University were reviewed.

RESULTS

We reviewed 131, 134 and 125 charts from the FP, IM and DM clinics, respectively. DM clinic had a higher percentage of patients with type 1 diabetes 43/125 (34.4%) compared with 7/131 (5.3%) in FP and 7/134 (5.2%) in IM clinics. A1c was measured in 99%, 97.8% and 100% subjects in FP, IM and DM clinics respectively. B.P. was measured in all subjects in all three clinics. Lipids were checked in 97.7%, 95.5% and 92% patients in FP, IM and DM clinics respectively. MA was measured at least once during the year preceding the office visit in 85.5%, 82.8% and 76.8% patients in FP, IM and DM clinics respectively. A1C was controlled (<7%) in 38.9, 43.3, 28.8% of patients in the FP, IM and DM clinics, respectively (p = 0.034). LDL was controlled (<100 mg/dl or 2.586 mmol/l) in 71.8, 64.9, 64% of patients in the FP, IM and DM clinics, respectively. MA was controlled (<30 mg/gm creatinine) in 60.3%, 51.5% and 60% patients in FP, IM and DM clinics respectively (P = 0.032). BP was controlled (<130/80) in 59.5, 67.2 and 52.8% patients in the FP, IM and DM clinics, respectively.

CONCLUSION

Testing rates for A1C, LDL, and MA were high, in both subspecialty and primary care clinics. However, the degree of control was not optimal. Significantly fewer patients in the DM clinic had A1c <7%, the cause of which may be multifactorial.

摘要

背景

糖尿病是一个严重的公共卫生问题，具有较高的发病率和死亡率。已有基于证据的指南来减少微血管和大血管并发症，但研究表明这些目标并未实现。我们试图比较学术医疗中心的专科诊所和初级保健诊所对美国糖尿病协会关于糖化血红蛋白（A1c）、血压（BP）、血脂（LDL）和微量白蛋白尿（MA）测量与控制指南的遵循情况。

方法

对密歇根州立大学家庭医学（FP）、内科（IM）和糖尿病（DM）诊所的390例糖尿病患者随机病历进行回顾。

结果

我们分别回顾了FP、IM和DM诊所的131份、134份和125份病历。DM诊所1型糖尿病患者的比例更高，为43/125（34.4%），而FP诊所为7/131（5.3%），IM诊所为7/134（5.2%）。FP、IM和DM诊所分别有99%、97.8%和100%的受试者测量了A1c。所有三个诊所的所有受试者均测量了血压。FP、IM和DM诊所分别有97.7%、95.5%和92%的患者检查了血脂。在就诊前一年中，FP、IM和DM诊所分别有85.5%、82.8%和76.8%的患者至少测量了一次MA。FP、IM和DM诊所分别有38.9%、43.3%和28.8%的患者A1C得到控制（<7%）（p = 0.034）。FP、IM和DM诊所分别有71.8%、64.9%和64%的患者LDL得到控制（<100mg/dl或2.586mmol/l）。FP、IM和DM诊所分别有60.3%、51.5%和60%的患者MA得到控制（<肌酐30mg/gm）（P = 0.032）。FP、IM和DM诊所分别有59.5%、67.2%和52.8%的患者血压得到控制（<130/80）。