Carrington Melinda J, Cohen Neale, Wiley Joshua F
Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
Diabetes Res Clin Pract. 2017 May;127:89-96. doi: 10.1016/j.diabres.2017.02.030. Epub 2017 Feb 27.
Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden.
We retrieved glycated haemoglobin (HbA) results and glucose-lowering prescription records from a patient-based medical database during 2005-2013. There were 275,480 available HbA measurements from 76,341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA levels exceeded 7% (53mmol/mol) in untreated (n=4888), non-insulin (n=11,534) and insulin treated (n=4049) patients was calculated as area under the curve (AUC) and months above threshold.
Average age of patients was 62.1±15.1years (47.1% women). HbA levels decreased from 7.1% (54mmol/mol) in 2005 to 6.6% (49mmol/mol) in 2013 and the proportion of patients who achieved a HbA target of <7% improved by 16% in men (53-69%) and 21% in women (55-76%). HbA levels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA goal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3±17.7months in untreated, 16.2±25.2months in non-insulin, and 26.8±34.6months in insulin-treated patients.
Amid considerable improvements, many treated patients still do not attain HbA levels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care.
糖尿病护理主要应用于初级保健环境，因此我们研究了血糖水平和目标的趋势，并估计了可避免的血糖负担。
我们从一个基于患者的医疗数据库中检索了2005年至2013年期间糖化血红蛋白（HbA）结果和降糖处方记录。来自澳大利亚各地321家诊所的960名全科医生管理的76341名个体有275480份可用的HbA测量值。根据性别、年龄和降糖治疗评估平均水平和血糖控制随时间的变化。计算未治疗（n = 4888）、非胰岛素治疗（n = 11534）和胰岛素治疗（n = 4049）患者中HbA水平超过7%（53 mmol/mol）的时间，以曲线下面积（AUC）和高于阈值的月数表示。
患者的平均年龄为62.1±15.1岁（女性占47.1%）。HbA水平从2005年的7.1%（54 mmol/mol）降至2013年的6.6%（49 mmol/mol）；达到HbA目标<7%的患者比例在男性中提高了16%（从53%提高到69%），在女性中提高了21%（从55%提高到76%）。男性的HbA水平随年龄增长而降低，随胰岛素治疗而升高；相应地，HbA目标达成率分别升高和降低。未治疗患者的可避免血糖负担为9.3±17.7个月，非胰岛素治疗患者为16.2±25.2个月，胰岛素治疗患者为26.8±34.6个月。
尽管有显著改善，但许多接受治疗的患者仍未达到HbA水平≤7%，且高于该阈值的时间有所延迟。在初级保健中，更早、更积极地强化管理可能会减少长时间的血糖控制不佳。
