类风湿关节炎的心血管疾病预防：糖尿病筛查指南的依从性。

Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines.

机构信息

From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada.

T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia.

出版信息

J Rheumatol. 2018 Oct;45(10):1367-1374. doi: 10.3899/jrheum.170973. Epub 2018 Jul 15.

DOI:10.3899/jrheum.170973

PMID:30008457

Abstract

OBJECTIVE

To evaluate compliance with diabetes screening guidelines for cardiovascular disease (CVD) prevention in rheumatoid arthritis (RA) compared to the general population.

METHODS

We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006 and followed until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines [i.e., testing plasma glucose (PG) at least once every 3 years after age 45] after excluding individuals with previous diabetes. Followup was divided into 3-year eligibility periods. Compliance was measured as the proportion of periods with ≥ 1 PG test performed. OR (95% CI) of compliance in RA (vs general population) was calculated using generalized estimating equation models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using the Mann-Whitney U test.

RESULTS

Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579 people in a general population group, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD 37%) of the eligible time periods in the RA sample and in 70.4% (SD 38%) for the general population (OR 1.05, 95% CI 1.02-1.09, p < 0.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p < 0.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests.

CONCLUSION

Compliance with general population guidelines for diabetes screening in RA was suboptimal, with little difference relative to the general population, despite a higher risk of CVD and diabetes.

摘要

目的

评估类风湿关节炎（RA）患者心血管疾病（CVD）预防的糖尿病筛查指南与普通人群的符合情况。

方法

我们进行了一项基于人群的 RA 队列的首次纵向研究，该队列包括 1996 年至 2006 年间不列颠哥伦比亚省所有现患 RA 病例，并随访至 2010 年，同时匹配了普通人群对照者。我们使用行政数据，在排除既往患有糖尿病的个体后，测量符合普通人群指南的情况[即，年龄 45 岁以后每 3 年至少检测一次血浆葡萄糖（PG）]。随访分为 3 年的资格期。通过计算至少进行了 1 次 PG 检测的时间段比例来衡量符合情况。使用广义估计方程模型，根据年龄和性别调整，计算 RA（与普通人群相比）的符合率的比值比（95%CI）。使用 Mann-Whitney U 检验比较每位患者的平均符合率。

结果

分析纳入了 22624 名 RA 患者，共 48724 个 3 年资格期；22579 名普通人群患者，共 51081 个 3 年资格期。在 RA 样本中，PG 检测率为 72.3%（标准差[SD]为 37%），普通人群为 70.4%（SD 为 38%）（比值比[OR]为 1.05，95%CI 为 1.02-1.09，p<0.0001）。RA 患者在其 71.4%的合格期内符合推荐的筛查指南，而普通人群为 70.6%（p<0.001）。RA 患者的筛查情况随着时间的推移相对普通人群有所改善。家庭医生几乎开了所有的 PG 检测单。