Mehta Sanjeev N, Goldfine Allison B, Abrahamson Martin J, McMullen William, Laffel Lori M B
Endocr Pract. 2016 Jun;22(6):689-98. doi: 10.4158/EP151080.OR. Epub 2016 Jan 27.
We aimed to compare metabolic control in adults with diabetes in the general population to those newly referred to a diabetes center and after 1 year of specialty care.
We performed a retrospective comparison of adults with diabetes aged ≥20 years data from the National Health and Nutrition Examination Survey (NHANES, n = 1,674) and a diabetes center (n = 3,128) from 2005-2010. NHANES participants represented the civilian, non-institutionalized U.S.
Diabetes center referrals lived primarily around eastern Massachusetts. The proportion attaining targets for glycated hemoglobin A1c (A1c), blood pressure (BP), low-density lipoprotein (LDL) cholesterol, or all 3 (ABC control) and the proportion prescribed medications to lower A1c, BP, or cholesterol were evaluated.
Compared to the general sample, a smaller proportion of new diabetes center referrals had A1c <7% (<53 mmol/mol, 24% vs. 53%, P<.001), BP <130/80 mm Hg (38% vs. 50%, P<.001), and ABC control (5.6% vs. 17%, P<.001) but not LDL<100 mg/dL (<2.6 mmol/L, 54% vs. 53%, P = .65). After 1 year, more diabetes center referrals attained targets for A1c (40%), BP (38%), LDL (67%), and ABC control (15%) (P<.001 for all versus baseline). ABC control was not different between the general sample and diabetes center referrals at 1 year (P = .16). After 1 year, a greater percentage of diabetes center referrals compared to the general sample were prescribed medications to lower glucose (95% vs. 72%), BP (79% vs. 64%), and cholesterol (77% vs. 54%)(all P<.001).
Compared to the general population, glycemic control was significantly worse for adults newly referred to the diabetes center. Within 1 year of specialty care, ABC control increased 270% in the setting of significant therapy escalation.
A1c = glycated hemoglobin A1c ABC = composite of A1c, blood pressure, and cholesterol ACEi = angiotensin-converting enzyme inhibitor ARB = angiotensin receptor blocker BMI = body mass index BP = blood pressure EHR = electronic health record LDL = low-density lipoprotein NCHS = National Center for Health Statistics NHANES = National Health and Nutrition Examination Survey PCP = primary care provider.
我们旨在比较普通人群中成年糖尿病患者与新转诊至糖尿病中心的患者以及接受专科护理1年后的代谢控制情况。
我们对2005年至2010年来自美国国家健康与营养检查调查（NHANES，n = 1674）和一个糖尿病中心（n = 3128）的≥20岁成年糖尿病患者数据进行了回顾性比较。NHANES参与者代表美国平民、非机构化人群。糖尿病中心的转诊患者主要居住在马萨诸塞州东部。评估了糖化血红蛋白A1c（A1c）、血压（BP）、低密度脂蛋白（LDL）胆固醇达到目标的比例或三者全部达到目标（ABC控制）的比例，以及开具降低A1c、BP或胆固醇药物的比例。
与总体样本相比，新转诊至糖尿病中心的患者中A1c<7%（<53 mmol/mol，24%对53%，P<.001）、BP<130/80 mmHg（38%对50%，P<.001）和ABC控制（5.6%对17%，P<.001）的比例较低，但LDL<100 mg/dL（<2.6 mmol/L，54%对53%，P = 0.65）的比例无差异。1年后，更多糖尿病中心转诊患者达到了A1c（40%）、BP（38%）、LDL（67%）和ABC控制（15%）的目标（与基线相比，所有P<.001）。1年后总体样本与糖尿病中心转诊患者之间的ABC控制无差异（P = 0.16）。1年后，与总体样本相比，糖尿病中心转诊患者中开具降低血糖药物（95%对72%）、BP药物（79%对64%）和胆固醇药物（77%对54%）的比例更高（所有P<.001）。
与普通人群相比，新转诊至糖尿病中心的成年患者血糖控制明显更差。在专科护理的1年内，在显著增加治疗的情况下，ABC控制提高了270%。
A1c = 糖化血红蛋白A1c；ABC = A1c、血压和胆固醇的综合指标；ACEi = 血管紧张素转换酶抑制剂；ARB = 血管紧张素受体阻滞剂；BMI = 体重指数；BP = 血压；EHR = 电子健康记录；LDL = 低密度脂蛋白；NCHS = 国家卫生统计中心；NHANES = 美国国家健康与营养检查调查；PCP = 初级保健提供者
