Robson R, Lacey A S, Luzio S D, Van Woerden H, Heaven M L, Wani M, Halcox J P J, Castilla-Guerra L, Dawson J, Hewitt J
Department of Geriatric Medicine, North Middlesex NHS Trust, London, UK.
College of Medicine, Swansea University, Swansea, UK.
Diabet Med. 2016 Apr;33(4):459-62. doi: 10.1111/dme.13057. Epub 2016 Jan 18.
To determine the proportion of people with diabetes who have HbA1c measured, what proportion achieve an HbA1c level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change in HbA1c level in the year before and the year after an incident stroke.
This study used the Secure Anonymised Information Linkage (SAIL) databank, which stores hospital data for the whole of Wales and ~ 65% of Welsh general practice records, to identify cases of stroke in patients with diabetes between 2000 and 2010. These were matched against patients with diabetes but without stroke disease. We assessed the frequency of HbA1c testing and change in HbA1c in the first year after stroke. Estimation was made of the proportion of patients achieving an HbA1c measurement ≤ 58 mmol/mol (7.5%).
There were 1741 patients with diabetes and stroke. Of these, 1173 (67.4%) had their HbA1c checked before their stroke and 1137 (65.3%) after their stroke. In the control group of 16 838 patients with diabetes but no stroke, 8413 (49.9%) and 9288 (55.1%) had their HbA1c checked before and after the case-matched stroke date, respectively. In patients with diabetes and stroke, HbA1c fell from 61-56 mmol/mol (7.7-7.3%) after their stroke (P < 0.001). Before the study, 55.0% of patients with stroke had an HbA1c ≥ 58 mmol/mol compared with 65.2% of control patients, these figures were 62.5% and 65.3% after the stroke.
The frequency of diabetes testing was higher in patients who had experienced a stroke before and after their incident stroke compared with control patients but did not increase after their stroke. Glucose control improved significantly in the year after a stroke.
确定接受糖化血红蛋白（HbA1c）检测的糖尿病患者比例、糖化血红蛋白水平达到<58 mmol/mol（7.5%）的患者比例、检测频率，以及首次中风前一年和中风后一年糖化血红蛋白水平是否有变化。
本研究使用安全匿名信息链接（SAIL）数据库，该数据库存储了整个威尔士的医院数据以及约65%的威尔士全科医疗记录，以识别2000年至2010年间糖尿病患者的中风病例。将这些病例与患有糖尿病但无中风疾病的患者进行匹配。我们评估了中风后第一年糖化血红蛋白检测的频率和糖化血红蛋白的变化。估算了糖化血红蛋白测量值≤58 mmol/mol（7.5%）的患者比例。
有1741例糖尿病合并中风患者。其中，1173例（67.4%）在中风前进行了糖化血红蛋白检查，1137例（65.3%）在中风后进行了检查。在16838例患有糖尿病但无中风的对照组患者中，分别有8413例（49.9%）和9288例（55.1%）在病例匹配的中风日期之前和之后进行了糖化血红蛋白检查。糖尿病合并中风患者中风后糖化血红蛋白从61 mmol/mol降至56 mmol/mol（7.7%降至7.3%）（P<0.001）。研究前，55.0%的中风患者糖化血红蛋白≥58 mmol/mol，而对照组患者为65.2%，中风后这些数字分别为62.5%和65.3%。
与对照组患者相比，中风患者在中风前后进行糖尿病检测的频率更高，但中风后并未增加。中风后一年血糖控制显著改善。
