Stem Maxwell S, Blachley Taylor S, Shtein Roni M, Herman William H, Gardner Thomas W, Stein Joshua D
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA.
Department of Internal Medicine, University of Michigan Medical School, USA; Department of Epidemiology, University of Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, USA.
J Diabetes Complications. 2016 Mar;30(2):323-8. doi: 10.1016/j.jdiacomp.2015.11.007. Epub 2015 Nov 10.
To assess how hemoglobin A1c (HbA1c) values might change following the diagnosis of the first complication from diabetes mellitus (DM).
Using a nationwide, longitudinal managed care network claims database (2001-2011), we identified patients with DM who experienced an initial diabetes-related complication. A paired t-test was used to compare average HbA1c levels before the initial complication was first diagnosed to average HbA1c levels following the diagnosis of the complication.
518 enrollees met study inclusion criteria. Patients with suboptimally controlled DM (defined as HbA1c>7% (53 mmol/mol)) prior to the diagnosis of their first diabetic complication demonstrated a clinically significant reduction in average HbA1c following the diagnosis of their first complication (mean pre-complication HbA1c=8.5 ± 1.5% (69 ± 17 mmol/mol) vs. mean post-complication HbA1c=7.9 ± 1.7% (63 ± 18 mmol/mol) (p<0.0001)).
Enrollees with suboptimally controlled DM may achieve better glycemic control following the diagnosis of a complication from DM. The results from this study, if confirmed in prospective studies, may provide a rationale for the earlier detection of complications from DM to facilitate improved glycemic control among patients with DM.
评估糖尿病（DM）首次并发症诊断后糖化血红蛋白（HbA1c）值可能如何变化。
利用一个全国性的纵向管理式医疗网络索赔数据库（2001 - 2011年），我们确定了经历首次糖尿病相关并发症的糖尿病患者。采用配对t检验比较首次并发症确诊前的平均HbA1c水平与并发症诊断后的平均HbA1c水平。
518名登记者符合研究纳入标准。在首次糖尿病并发症诊断前血糖控制欠佳（定义为HbA1c>7%（53 mmol/mol））的患者，在首次并发症诊断后平均HbA1c有临床显著降低（并发症前平均HbA1c = 8.5 ± 1.5%（69 ± 17 mmol/mol），并发症后平均HbA1c = 7.9 ± 1.7%（63 ± 18 mmol/mol）（p<0.0001））。
血糖控制欠佳的糖尿病登记者在糖尿病并发症诊断后可能实现更好的血糖控制。本研究结果若在前瞻性研究中得到证实，可能为更早发现糖尿病并发症以促进糖尿病患者血糖控制改善提供理论依据。
