Bralić Lang Valerija, Bergman Marković Biserka
a Private Family Physician Office affiliated to University of Zagreb, School of Medicine , Zagreb , Croatia ;
b Department of Family Medicine , University of Zagreb, School of Medicine , Zagreb , Croatia.
Scand J Prim Health Care. 2016;34(1):66-72. doi: 10.3109/02813432.2015.1132886. Epub 2016 Feb 6.
To the authors' knowledge, there are few valid data that describe the prevalence of comorbidity in type 2 diabetes mellitus (T2DM) patients seen in family practice. This study aimed to investigate the prevalence of comorbidities and their association with elevated (≥ 7.0%) haemoglobin A1c (HbA1c) using a large sample of T2DM patients from primary care practices.
A cross-sectional study in which multivariate logistic regression was applied to explore the association of comorbidities with elevated HbA1c.
Primary care practices in Croatia.
Altogether, 10 264 patients with diabetes in 449 practices.
Comorbidities and elevated HbA1c.
In total 7979 (77.7%) participants had comorbidity. The mean number of comorbidities was 1.6 (SD 1.28). Diseases of the circulatory system were the most common (7157, 69.7%), followed by endocrine and metabolic diseases (3093, 30.1%), and diseases of the musculoskeletal system and connective tissue (1437, 14.0%). After adjustment for age and sex, the number of comorbidities was significantly associated with HbA1c. The higher the number of comorbidities, the lower the HbA1c. The prevalence of physicians' inertia was statistically significantly and negatively associated with the number of comorbidities (Mann-Whitney U test, Z = -12.34; p < 0.001; r = -0.12).
There is a high prevalence of comorbidity among T2DM patients in primary care. A negative association of number of comorbidities and HbA1c is probably moderated by physicians' inertia in treatment of T2DM strictly according to guidelines.
There is a high prevalence of comorbidity among T2DM patients in primary care. Patients with breast cancer, obese patients, and those with dyslipidaemia and ischaemic heart disease were more likely to have increased HbA1c. The higher the number of comorbidities, the lower the HbA1c.
据作者所知，几乎没有有效数据描述在家庭医疗中就诊的2型糖尿病（T2DM）患者的合并症患病率。本研究旨在利用来自基层医疗诊所的大量T2DM患者样本，调查合并症的患病率及其与血红蛋白A1c（HbA1c）升高（≥7.0%）之间的关联。
一项横断面研究，应用多因素逻辑回归来探讨合并症与HbA1c升高之间的关联。
克罗地亚的基层医疗诊所。
449家诊所中总计10264例糖尿病患者。
合并症和HbA1c升高。
共有7979例（77.7%）参与者患有合并症。合并症的平均数量为1.6（标准差1.28）。循环系统疾病最为常见（7157例，69.7%），其次是内分泌和代谢疾病（3093例，30.1%），以及肌肉骨骼系统和结缔组织疾病（1437例，14.0%）。在对年龄和性别进行调整后，合并症的数量与HbA1c显著相关。合并症数量越多，HbA1c越低。医生惰性的患病率与合并症数量在统计学上显著负相关（曼-惠特尼U检验，Z = -12.34；p < 0.001；r = -0.12）。
基层医疗中T2DM患者的合并症患病率很高。合并症数量与HbA1c之间的负相关可能因医生在严格按照指南治疗T2DM方面的惰性而受到影响。
基层医疗中T2DM患者的合并症患病率很高。乳腺癌患者、肥胖患者以及血脂异常和缺血性心脏病患者的HbA1c更有可能升高。合并症数量越多，HbA1c越低。
