Coons Michael J, Greiver Michelle, Aliarzadeh Babak, Meaney Christopher, Moineddin Rahim, Williamson Tyler, Queenan John, Yu Catherine H, White David G, Kiran Tara, Kane Jennifer J
Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
Medical Bariatric Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada.
BMJ Open Diabetes Res Care. 2017 Jun 8;5(1):e000316. doi: 10.1136/bmjdrc-2016-000316. eCollection 2017.
Diabetes guidelines recommend individualized glycemic targets: tighter control in younger, healthier patients and consideration of more moderate control in the elderly and those with coexisting illnesses. Our objective was to examine whether glycemic control varied by age and comorbidities in Canadian primary care.
Cross-sectional study using data from the electronic medical records of 537 primary care providers across Canada; 30 416 patients with diabetes, aged 40 or above, with at least one encounter and one hemoglobin A1c (HbA1c) measurement between 1 January 2012 and 31 December 2013. The outcome was the most recent HbA1c, categorized into three levels of control: tight (<7.0% or <53 mmol/mol), moderate (7.0%-8.5%, 53 mmol/mol-69.5 mmol/mol) and uncontrolled (>8.5% or >69.5 mmol/mol). We adjusted for several factors associated with glycemic control including treatment intensity.
Younger patients (aged 40-49) were more likely to have moderate as opposed to tight control than the older patients (aged 80+) (OR 1.28; 95% CI 1.11 to 1.49, p=0.001). The youngest were also more likely to have uncontrolled as opposed to moderately controlled glycemia (OR 3.39; 95% CI 2.75 to 4.17, p<0.0001). Patients with no or only one comorbidity were more likely to have moderate as opposed to tight control than those with three or more comorbidities (OR 1.66;95% CI 1.46 to 1.90, p<0.0001).
Levels of glycemic control, given age and comorbidities appear to differ from guideline recommendations. Research is needed to understand these discrepancies and develop methods to assist providers in personalizing glycemic targets.
糖尿病指南推荐个体化血糖目标：在年轻、健康的患者中进行更严格的控制，而对于老年人和患有并存疾病的患者则考虑更适度的控制。我们的目的是研究在加拿大初级保健中血糖控制是否因年龄和合并症而异。
采用横断面研究，数据来自加拿大537名初级保健提供者的电子病历；30416例40岁及以上的糖尿病患者，在2012年1月1日至2013年12月31日期间至少有一次就诊和一次糖化血红蛋白（HbA1c）测量。结果指标是最近的HbA1c，分为三个控制水平：严格控制（<7.0%或<53 mmol/mol）、适度控制（7.0%-8.5%，53 mmol/mol-69.5 mmol/mol）和未控制（>8.5%或>69.5 mmol/mol）。我们对与血糖控制相关的几个因素进行了调整，包括治疗强度。
与老年患者（80岁以上）相比，年轻患者（40-49岁）更有可能进行适度控制而非严格控制（比值比1.28；95%置信区间1.11至1.49，p=0.001）。最年轻的患者也更有可能血糖未得到控制而非适度控制（比值比3.39；95%置信区间2.75至4.17，p<0.0001）。与患有三种或更多合并症的患者相比，没有合并症或只有一种合并症的患者更有可能进行适度控制而非严格控制（比值比1.66；95%置信区间1.46至1.90，p<0.0001）。
考虑到年龄和合并症，血糖控制水平似乎与指南建议不同。需要开展研究以了解这些差异，并开发方法来帮助医疗服务提供者实现血糖目标的个性化。
