Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Diabetes Obes Metab. 2018 Oct;20(10):2494-2499. doi: 10.1111/dom.13399. Epub 2018 Jun 26.
The majority of patients with type 2 diabetes do not reach target levels of glycated haemoglobin (HbA1c < 7%). We investigated the prevalence of HbA1c-target achievement and opportunities afforded by lifestyle and pharmacological treatment to increase target achievement. We performed cross-sectional analyses of baseline data from the Diabetes and Lifestyle Cohort Twente-1 (DIALECT-1). Patients were divided according to (1) HbA1c <53 and ≥53 mmol/mol (<7%) and (2) non-insulin treatment and tertiles of daily insulin use. We found that 161 (36%) patients achieved the target HbA1c level. Patients with HbA1c ≥53 mmol/mol had a longer duration of diabetes (13 [8-20] vs 9 [4-14] years; P < .001) and more frequently were insulin-users (76% vs 41%, P < .001). Patients in the highest tertile of insulin use had a higher body mass index than those in the lowest tertile (35.8 ± 5.5 vs 29.8 ± 5.5 kg/m ; P < .001). Achievement of target HbA1c is low in this type 2 diabetes population. High resistance to pharmacological treatment, paralleled with high body mass index, illustrates that increasing insulin sensitivity through lifestyle intervention is the best opportunity to improve HbA1c target achievement in this real-life population.
大多数 2 型糖尿病患者无法达到糖化血红蛋白（HbA1c < 7%）的目标水平。我们研究了生活方式和药物治疗实现 HbA1c 目标的患病率和机会，以增加目标达标率。我们对糖尿病和生活方式队列特温特-1 （DIALECT-1）的基线数据进行了横断面分析。患者根据（1）HbA1c < 53 和 ≥53 mmol/mol（<7%）和（2）非胰岛素治疗和每日胰岛素使用三分位数进行分组。我们发现，161 名（36%）患者达到了目标 HbA1c 水平。HbA1c ≥53 mmol/mol 的患者糖尿病病程更长（13 [8-20] vs 9 [4-14]年；P <.001），更常使用胰岛素（76% vs 41%，P <.001）。胰岛素使用最高三分位数的患者体重指数高于最低三分位数（35.8 ± 5.5 vs 29.8 ± 5.5 kg/m ；P <.001）。在该 2 型糖尿病人群中，达到目标 HbA1c 的比例较低。药物治疗的高阻力，与高体重指数相平行，表明通过生活方式干预增加胰岛素敏感性是改善该实际人群 HbA1c 目标达标率的最佳机会。
