Gardiner Fergus William, Nwose Ezekiel Uba, Bwititi Phillip Taderera, Crockett Judith, Wang Lexin
School of Community Health, Charles Sturt University, Canberra, ACT, Australia.
Calvary Hospital, Canberra, ACT, Australia.
SAGE Open Med. 2017 Nov 17;5:2050312117740989. doi: 10.1177/2050312117740989. eCollection 2017.
There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.
患有慢性肾脏病（CKD）、糖尿病（DM）和高血压（HT）的患者数量众多，但糖尿病和/或慢性肾脏病患者的血压（BP）控制目标是否达成尚不清楚。因此，本篇叙述性综述调查了澳大利亚针对慢性肾脏病、糖尿病和高血压患者旨在取得理想临床效果的服务的相关证据。研究考虑了与这些患者的病理诊断和管理以及管理复杂性相关的文献。这涉及1993年至2016年间发表在PubMed上的文章中的证据，包括原创研究，尽可能侧重于随机对照试验和前瞻性研究、系统综述及其他综述文章、荟萃分析、专家共识文件和专业学会指南，如澳大利亚国家心脏基金会、美国糖尿病协会、卫生部、澳大利亚皇家病理学家学会和澳大利亚急诊医学学院发布的指南。基于所综述的文献，尚不清楚糖尿病住院服务、内分泌门诊服务和心脏康复服务等项目在实现指南建议方面的效果如何。也不清楚临床医生在努力遵循糖尿病、高血压和血糖控制建议时如何或是否受到复杂性的阻碍，以及临床惰性的潜在原因。需要开展进一步研究以确定患者所需的血压和血糖控制的达成程度，以及临床惰性是否构成障碍。
