Visockienė Žydrūnė, Šiaulienė Laura, Puronaitė Roma, Šapoka Virginijus, Kasiulevičius Vytautas
Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Lithuania.
Centre of Endocrinology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania.
Acta Med Litu. 2016;23(2):126-134. doi: 10.6001/actamedica.v23i2.3329.
Essential data on the quality of diabetes care needed for the development of National Diabetes Programme in Lithuania are lacking. The aim of the study was to assess the quality of diabetes care compared to the local guidelines in Vilnius, Lithuania.
Retrospective data collection covering the period from 2012 to 2013 was performed in 5 Vilnius outpatient clinics assessing process and outcome indicators in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) subjects.
In a sample of 1,719 patients (58.9% women, 92.6% T2DM) the annual HbA1c assessment rate was 88.6%. Glycaemic control was significantly better in T2DM compared to T1DM patients: average HbA1c was 7.0 ± 1.4% vs 9.1 ± 1.8% and HbA1c ≤ 7% in 59 vs 9.4%, respectively ( < 0.001); referrals to an endocrinologist were recommended in 56.3% of cases. Annual screening for diabetic foot, retinopathy, nephropathy, renal function and lipids was performed in 4.6, 24.4, 2.3, 29.3 and 13.2% of patients, respectively, with higher performance rate of retinal screening and urinary microalbumin in T1DM; BMI and blood pressure were recorded for 50.2 and 97.2% of patients, respectively. Prevalence of nephropathy, polyneuropathy, retinopathy, and angiopathy was 8.4, 36.2, 10.7 and 7.7%, respectively, with the higher prevalence in T1DM.
The analysis revealed good glycaemic control in T2DM, but insufficient in T1DM. Continuous monitoring of diabetes complications and cardiovascular risk factors did not meet the local Diabetes Care Guidelines.
立陶宛国家糖尿病项目的发展缺乏有关糖尿病护理质量的关键数据。本研究旨在对照立陶宛维尔纽斯的当地指南评估糖尿病护理质量。
2012年至2013年期间，在维尔纽斯的5家门诊诊所进行回顾性数据收集，评估1型糖尿病（T1DM）和2型糖尿病（T2DM）患者的过程指标和结局指标。
在1719例患者样本中（58.9%为女性，92.6%为T2DM），年度糖化血红蛋白（HbA1c）评估率为88.6%。与T1DM患者相比，T2DM患者的血糖控制明显更好：平均HbA1c分别为7.0±1.4%和9.1±1.8%，HbA1c≤7%的比例分别为59%和9.4%（P<0.001）；56.3%的病例建议转诊至内分泌科医生处。分别有4.6%、24.4%、2.3%、29.3%和13.2%的患者进行了糖尿病足、视网膜病变、肾病、肾功能和血脂的年度筛查，T1DM患者的视网膜筛查和尿微量白蛋白检测率更高；分别有50.2%和97.2%的患者记录了体重指数（BMI）和血压。肾病、多发性神经病变、视网膜病变和血管病变的患病率分别为8.4%、36.2%、10.7%和7.7%，T1DM患者的患病率更高。
分析显示T2DM患者血糖控制良好，但T1DM患者血糖控制不足。糖尿病并发症和心血管危险因素的持续监测未达到当地糖尿病护理指南的要求。
