Goderis Geert, Vaes Bert, Van den Akker Marjan, Elli Steven, Mathieu Chantal, Buntinx Frank, Henrard Séverine
Department of General Practice, KU Leuven (KUL), Leuven, Belgium.
Department of General Practice, KU Leuven (KUL), Leuven, Belgium.
Prim Care Diabetes. 2017 Oct;11(5):482-489. doi: 10.1016/j.pcd.2017.05.008. Epub 2017 Jun 23.
To assess factors associated with Prolonged Inaction (PI) in insulin-naïve patients with Type 2 Diabetes Mellitus (T2DM). PI was defined as the absence of treatment initiation or intensification for ≥12 months despite HbA1c >7% (53mmol/mol).
A retrospective cohort study was conducted based on data from Intego, a Flemish General Practice registry. The study period ranged from January 1, 2006 to December 31, 2013. Patients with insulin therapy before the start of the study period were excluded from the analysis. A mixed effects logistic regression was used to assess the association of PI with the presence of co-morbidities, co-medications, process parameters and bio-clinical parameters.
In a population of 2265 patients with T2DM, 578 insulin-naive patients presented with an HbA1c >7% (53mmol/mol) for ≥12 months. Median follow-up was 1.2 years, median age 67 years, 55% were male. PI was present in 340 patients (59%) and associated with moderate to severe Chronic Kidney Disease, absence of a mental health disorder, less frequent HbA1c measurements, lower HbA1c values and a smaller number of co-medications.
PI is highly prevalent in primary care, particularly in patients with less complex disease status and with less intensive follow-up.
评估初治2型糖尿病（T2DM）患者中与长期未采取行动（PI）相关的因素。PI定义为尽管糖化血红蛋白（HbA1c）>7%（53mmol/mol），但≥12个月未开始治疗或强化治疗。
基于佛兰德全科医疗登记处Intego的数据进行回顾性队列研究。研究期间为2006年1月1日至2013年12月31日。研究开始前接受胰岛素治疗的患者被排除在分析之外。采用混合效应逻辑回归评估PI与合并症、联合用药、过程参数和生物临床参数之间的关联。
在2265例T2DM患者中，578例初治患者HbA1c>7%（53mmol/mol）持续≥12个月。中位随访时间为1.2年，中位年龄67岁，55%为男性。340例患者（59%）存在PI，且与中度至重度慢性肾脏病、无精神疾病、HbA1c检测频率较低、HbA1c值较低以及联合用药数量较少相关。
PI在初级医疗中非常普遍，尤其是在疾病状态不太复杂且随访不太密集的患者中。
