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筛查发现糖尿病诊断后心脏保护药物的变化及健康相关生活质量:ADDITION-剑桥队列研究结果

Change in cardio-protective medication and health-related quality of life after diagnosis of screen-detected diabetes: Results from the ADDITION-Cambridge cohort.

作者信息

Black J A, Long G H, Sharp S J, Kuznetsov L, Boothby C E, Griffin S J, Simmons R K

机构信息

MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge CB2 0QQ, United Kingdom.

MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge CB2 0QQ, United Kingdom; Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, United Kingdom.

出版信息

Diabetes Res Clin Pract. 2015 Jul;109(1):170-7. doi: 10.1016/j.diabres.2015.04.013. Epub 2015 Apr 23.

Abstract

AIMS

Establishing a balance between the benefits and harms of treatment is important among individuals with screen-detected diabetes, for whom the burden of treatment might be higher than the burden of the disease. We described the association between cardio-protective medication and health-related quality of life (HRQoL) among individuals with screen-detected diabetes.

METHODS

867 participants with screen-detected diabetes underwent clinical measurements at diagnosis, one and five years. General HRQoL (EQ5D) was measured at baseline, one- and five-years, and diabetes-specific HRQoL (ADDQoL-AWI) and health status (SF-36) at one and five years. Multivariable linear regression was used to quantify the association between change in HRQoL and change in cardio-protective medication.

RESULTS

The median (IQR) number of prescribed cardio-protective agents was 2 (1 to 3) at diagnosis, 3 (2 to 4) at one year and 4 (3 to 5) at five years. Change in cardio-protective medication was not associated with change in HRQoL from diagnosis to one year. From one year to five years, change in cardio-protective agents was not associated with change in the SF-36 mental health score. One additional agent was associated with an increase in the SF-36 physical health score (2.1; 95%CI 0.4, 3.8) and an increase in the EQ-5D (0.05; 95%CI 0.02, 0.08). Conversely, one additional agent was associated with a decrease in the ADDQoL-AWI (-0.32; 95%CI -0.51, -0.13), compared to no change.

CONCLUSIONS

We found little evidence that increases in the number of cardio-protective medications impacted negatively on HRQoL among individuals with screen-detected diabetes over five years.

摘要

目的

在筛查发现的糖尿病患者中,平衡治疗的益处和危害非常重要,因为这类患者的治疗负担可能高于疾病负担。我们描述了筛查发现的糖尿病患者使用心脏保护药物与健康相关生活质量(HRQoL)之间的关联。

方法

867名筛查发现的糖尿病参与者在诊断时、1年和5年时接受了临床测量。在基线、1年和5年时测量一般健康相关生活质量(EQ5D),在1年和5年时测量糖尿病特异性健康相关生活质量(ADDQoL-AWI)和健康状况(SF-36)。采用多变量线性回归来量化健康相关生活质量的变化与心脏保护药物变化之间的关联。

结果

诊断时开具的心脏保护药物的中位数(四分位间距)为2(1至3)种,1年时为3(2至4)种,5年时为4(3至5)种。从诊断到1年,心脏保护药物的变化与健康相关生活质量的变化无关。从1年到5年,心脏保护药物的变化与SF-36心理健康评分的变化无关。每增加一种药物与SF-36身体健康评分增加(2.1;95%置信区间0.4,3.8)和EQ-5D增加(0.05;95%置信区间0.02,0.08)相关。相反,与无变化相比,每增加一种药物与ADDQoL-AWI降低(-0.32;95%置信区间-0.51,-0.13)相关。

结论

我们几乎没有发现证据表明,在五年内,筛查发现的糖尿病患者使用的心脏保护药物数量增加会对健康相关生活质量产生负面影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b53/4504034/c9d364c35ac6/gr1.jpg

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