在一个大型综合医疗体系中，2 型糖尿病患者的临床特征、并发症、合并症和治疗模式。
Clinical characteristics, complications, comorbidities and treatment patterns among patients with type 2 diabetes mellitus in a large integrated health system.
机构信息
Department of Endocrinology , Cleveland Clinic Cleveland , Cleveland, Ohio , USA.
Novo Nordisk Inc , Plainsboro, New Jersey , USA.
出版信息
BMJ Open Diabetes Res Care. 2015 Jul 22;3(1):e000093. doi: 10.1136/bmjdrc-2015-000093. eCollection 2015.
PURPOSE
To compare the prevalence of diabetes-related complications and comorbidities, clinical characteristics, glycemic control, and treatment patterns in patients with type 2 diabetes (T2D) within a large integrated healthcare system in 2008 vs 2013.
METHODS
An electronic health record system was used to create a cross-sectional summary of all patients with T2D as on 1 July 2008 and 1 July 2013. Differences between the two data sets were assessed after adjusting for age, gender, race, and household income.
RESULTS
In 2008 and 2013, 24 493 and 41 582 patients with T2D were identified, respectively, of which the majority were male (52.3% and 50.1%) and Caucasian (79% and 75.2%). The mean ages (years) were 64.8 and 64.3. The percentages of patients across the defined A1C categories were 64.3 and 66.7 for <7%, 21.1 and 18.8 for 7-7.9%, 7.8 and 7.5 for 8-8.9%, and 6.8 and 7.0 for ≥9% in 2008 and 2013, respectively. The most prevalent T2D-related comorbidities were hypertension (82.5% and 87.2%) and cardiovascular disease (26.9% and 22.3%) in 2008 and 2013, respectively. Thiazolidinedione and sulfonylurea use decreased, whereas metformin and dipeptidyl peptidase-4 inhibitor use increased in the 5-year period.
CONCLUSIONS
Patients with T2D are characterized by a high number of comorbidities. Over 85% of the patients had an A1C<8% within our integrated health delivery system in 2008 and 2013. In 2008 and 2013, metformin therapy was the most commonly utilized antidiabetic agent, and sulfonylureas were the most commonly utilized oral antidiabetic agent in combination with metformin. As integrated health systems assume greater shared financial risk in newer payment models, achieving glycemic targets (A1C) and the management of comorbidities will become ever-more important, for preventing diabetes-related complications, as well as to ensure reimbursement for the medical care that is rendered to patients with diabetes.
目的
比较 2008 年和 2013 年在一个大型综合医疗保健系统中，2 型糖尿病（T2D）患者的糖尿病相关并发症和合并症、临床特征、血糖控制和治疗模式的患病率。
方法
利用电子健康记录系统，创建了一个截止到 2008 年 7 月 1 日和 2013 年 7 月 1 日所有 T2D 患者的横截面摘要。在调整年龄、性别、种族和家庭收入后，评估了两个数据集之间的差异。
结果
2008 年和 2013 年分别确定了 24493 例和 41582 例 T2D 患者，其中大多数为男性（52.3%和 50.1%）和白种人（79%和 75.2%）。平均年龄（岁）分别为 64.8 和 64.3。根据定义的 A1C 类别，2008 年和 2013 年分别有 64.3%和 66.7%的患者 A1C<7%，21.1%和 18.8%的患者 A1C 为 7-7.9%，7.8%和 7.5%的患者 A1C 为 8-8.9%，6.8%和 7.0%的患者 A1C≥9%。2008 年和 2013 年最常见的 T2D 相关合并症分别为高血压（82.5%和 87.2%）和心血管疾病（26.9%和 22.3%）。噻唑烷二酮和磺酰脲类药物的使用减少，而二甲双胍和二肽基肽酶-4 抑制剂的使用在 5 年内增加。
结论
T2D 患者的特点是合并症数量多。在我们的综合医疗服务系统中，2008 年和 2013 年超过 85%的患者 A1C<8%。在 2008 年和 2013 年，二甲双胍是最常用的抗糖尿病药物，磺酰脲类药物是与二甲双胍联合使用的最常用的口服抗糖尿病药物。随着综合医疗系统在新的支付模式下承担更大的共同财务风险，实现血糖目标（A1C）和管理合并症将变得更加重要，这不仅有助于预防糖尿病相关并发症，还确保了对糖尿病患者提供医疗服务的报销。
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