对在初级保健机构接受治疗的多民族亚洲2型糖尿病患者血糖控制决定因素的5年纵向研究。

5-Year longitudinal study of determinants of glycemic control for multi-ethnic Asian patients with type 2 diabetes mellitus managed in primary care.

作者信息

Tan Ngiap Chuan, Barbier Sylvaine, Lim Wei Yen, Chia Kee Seng

机构信息

SingHealth Polyclinics, 167, Jalan Bukit Merah, Tower 5, #15-10, Connection One, Singapore 150167, Singapore; Duke NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.

Center for Quantitative Medicine, Duke NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore.

出版信息

Diabetes Res Clin Pract. 2015 Nov;110(2):218-23. doi: 10.1016/j.diabres.2015.07.010. Epub 2015 Aug 28.

DOI:10.1016/j.diabres.2015.07.010

PMID:26385596

Abstract

AIM

This study aims to determine the risk factors associated with glycaemic control of ambulatory patients with type 2 diabetes mellitus (T2DM) who are managed in primary care.

METHOD

The data was retrieved from a primary care site within the Singapore Consortium of Cohort Studies-Diabetes Cohort (SCCS-DC). Demographic and clinical variables were described, in association with the risk of having a deteriorating glycaemic control (defined as an absolute increase of at least 1% HbA1c from one year to a subsequent year). Next, multivariate model was performed to define the independent effect of each factor. The longitudinal analysis of the HbA1c was performed using Generalised Estimating Equation (GEE).

RESULTS

The 5 year longitudinal data of 1256 patients (54% Chinese, 25% Malays, 12% Indians, 9% others) were analysed. Their mean HbA1c decreased by <0.1% in the initial 3 years, but increased thereafter. 12% of them had absolute HbA1c increment of ≥1% in the first year, and 22% over 5 years. Based on GEE analysis, insulin, was associated with an increase of HbA1c (≥1%) from one year to another (all p<0.05). Compared with Chinese patients, Malays had higher HbA1c (+0.3%), Indians (+0.3%), and others (+0.2%), (all p<0.01). Patients with retinopathy had higher HbA1c (+0.2%) and those with cataract had lower mean HbA1c (-0.2%) (p<0.01).

CONCLUSION

Most cohort patients achieved glycaemic control within the initial 3 years. Patients of Malay and Indian ethnicity and those with retinopathy were associated with subsequent risk of glycaemic control deterioration. Those with cataract were associated with trend towards improved glycaemic control.

摘要

目的

本研究旨在确定在初级保健机构接受管理的非卧床2型糖尿病（T2DM）患者血糖控制的相关危险因素。

方法

数据取自新加坡队列研究联盟-糖尿病队列（SCCS-DC）中的一个初级保健机构。描述了人口统计学和临床变量，并分析了血糖控制恶化（定义为糖化血红蛋白（HbA1c）从一年到下一年绝对增加至少1%）的风险。接下来，进行多变量模型分析以确定每个因素的独立影响。使用广义估计方程（GEE）对HbA1c进行纵向分析。

结果

分析了1256例患者（54%为华裔，25%为马来裔，12%为印度裔，9%为其他族裔）的5年纵向数据。他们的平均HbA1c在最初3年下降了<0.1%，但此后有所上升。其中12%的患者在第一年HbA1c绝对增量≥1%，5年期间这一比例为22%。基于GEE分析，胰岛素与HbA1c从一年到下一年增加≥1%相关（所有p<0.05）。与华裔患者相比，马来裔患者的HbA1c更高（+0.3%），印度裔患者（+0.3%），以及其他族裔患者（+0.2%）（所有p<0.01）。患有视网膜病变的患者HbA1c更高（+0.2%），而患有白内障的患者平均HbA1c更低（-0.2%）（p<0.01）。