Kim Sin Gon, Hahm Jong Ryeal, Kim Duk Kyu, Cho Sung Rae, Choi Dong Seop
Department of Internal Medicine, Korea University College of Medicine Seoul, Korea.
Department of Internal Medicine, Gyeongsang National University School of Medicine Jinju, Korea.
J Diabetes Investig. 2015 May;6(3):317-24. doi: 10.1111/jdi.12284. Epub 2014 Nov 17.
AIMS/INTRODUCTION: To assess the current status of glycemic control in patients with type 2 diabetes treated with a combination of metformin and sulfonylurea for >3 months, as measured by glycosylated hemoglobin (HbA1c).
Data on patient demographics, diabetic complications, HbA1c, fasting plasma glucose (FPG) and type of treatment were collected in this multicenter, cross-sectional, non-interventional study.
From April 2008 to February 2009, 5,628 patients were recruited from 299 centers in Korea. Patients characteristics (mean ± SD) were as follows: age 58.4 ± 10.8 years, duration of diabetes 6.1 ± 4.7 years, body mass index 24.7 ± 2.9 kg/m(2), HbA1c 7.77 ± 1.22%, FBG 147.4 ± 46.5 mmol/L and FPG 164.0 ± 54.3 mmol/L. The most common diabetic complication was neuropathy (22.5%), followed by retinopathy (18.3%) and microalbuminuria (16.1%). Just 1,524 (27.1%) patients achieved HbA1c ≤7%. A higher number of patients (32.6%) treated by endocrinologists achieved HbA1c ≤7% than those treated by internists (24.4%) and primary care physicians (23.2%). In multivariate analyses, diabetic retinopathy (odds ratio 0.455, 95% confidence interval 0.341-0.606), nephropathy (odds ratio 0.639, 95% confidence interval 0.43-0.949), diabetes for ≥5 years (odds ratio 0.493, 95% confidence interval 0.4-0.606) and older age added by 1 year (odds ratio 1.019, 95% confidence interval 1.01-1.029) was significantly associated with achieving target HbA1c. In addition, treatment by endocrinologists rather than internists significantly increased chances of achieving target HbA1c (odds ratio 1.417, 95% confidence interval 1.146-1.751).
The majority of patients with type 2 diabetes in Korea had inadequate glycemic control, despite receiving a combination of metformin and sulfonylurea.
目的/引言:通过糖化血红蛋白(HbA1c)评估接受二甲双胍和磺脲类药物联合治疗3个月以上的2型糖尿病患者的血糖控制现状。
在这项多中心、横断面、非干预性研究中收集了患者的人口统计学数据、糖尿病并发症、HbA1c、空腹血糖(FPG)和治疗类型。
2008年4月至2009年2月,从韩国299个中心招募了5628例患者。患者特征(均值±标准差)如下:年龄58.4±10.8岁,糖尿病病程6.1±4.7年,体重指数24.7±2.9kg/m²,HbA1c 7.77±1.22%,空腹血糖(FBG)147.4±46.5mmol/L,餐后血糖164.0±54.3mmol/L。最常见的糖尿病并发症是神经病变(22.5%),其次是视网膜病变(18.3%)和微量白蛋白尿(16.1%)。仅有1524例(27.1%)患者HbA1c≤7%。内分泌科医生治疗的患者中达到HbA1c≤7%的比例(32.6%)高于内科医生(24.4%)和初级保健医生(23.2%)治疗的患者。在多变量分析中,糖尿病视网膜病变(比值比0.455,95%置信区间0.341 - 0.606)、肾病(比值比0.639,95%置信区间0.43 - 0.949)、糖尿病病程≥5年(比值比0.493,95%置信区间0.4 - 0.606)以及年龄每增加1岁(比值比1.019,95%置信区间1.01 - 1.029)与达到目标HbA1c显著相关。此外,由内分泌科医生而非内科医生进行治疗显著增加了达到目标HbA1c的机会(比值比1.417,95%置信区间1.146 - 1.751)。
韩国大多数2型糖尿病患者尽管接受了二甲双胍和磺脲类药物联合治疗,但血糖控制仍不理想。