Tan Mei Lyn, Manski-Nankervis Jo-Anne, Thuraisingam Sharmala, Jenkins Alicia, O'Neal David, Furler John
Department of General Practice, University of Melbourne, Level 1, 200 Berkeley St, Carlton, VIC, 3010, Australia.
NHMRC Clinical Trials Centre, University of Sydney, Levels 4-6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia.
BMC Endocr Disord. 2018 Jul 21;18(1):47. doi: 10.1186/s12902-018-0279-6.
Optimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-min over days and may be more readily understood. Given that T2D is more common in lower socioeconomic settings, we aim to study relationships between socioeconomic status (SES) and percentage time in glucose target range (TIR) which is a key metric calculated from CGM.
Analysis of baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) randomised controlled trial (October 2016 - November 2017) of 300 people with T2D from 25 Victorian General Practices. FreeStyle Libre Pro® sensor patch was used for this study. SES was defined by the Index of Relative Socio-economic Disadvantage (IRSD) and educational attainment. Univariable and multivariable mixed-effects linear regression analyses controlling for age, BMI, diet, exercise and study arm were performed.
One hundred and sixty-seven (60.1%) participants were male, the mean (SD) participant age was 61.0 (9.7) years, and the mean (SD) duration of CGM use was 12.3 (2.5) days. The 10th IRSD decile (least disadvantaged) was associated with a 15% higher TIR vs. the 1st decile (most disadvantaged) (95% CI 5, 25; p = 0.003) and a 0.6% lower HbA1c (95% CI 0.1, 1; p = 0.03). There was no evidence of an association between educational attainment and TIR/HbA1c.
Higher SES measured at an area level is associated with better achievement of glycaemic target using complementary measures of HbA1c and TIR in the GP-OSMOTIC cohort. Given that TIR may be more easily used in patient education and self-management support compared to HbA1c values, the social gradient identified in TIR provides an opportunity for clinicians and policy makers to address health inequities in T2D.
Australian and New Zealand Clinical Trials Registry Trial ACTRN12616001372471 , prospective, Date registered 4/10/2016.
糖化血红蛋白（HbA1c）水平所反映的最佳血糖水平是降低2型糖尿病（T2D）并发症的关键。然而，大多数T2D患者对HbA1c的记忆和理解并不理想。连续血糖监测（CGM）可在数天内每隔5至15分钟测量一次血糖水平，可能更容易理解。鉴于T2D在社会经济地位较低的人群中更为常见，我们旨在研究社会经济地位（SES）与血糖目标范围内时间百分比（TIR）之间的关系，TIR是根据CGM计算得出的关键指标。
对来自维多利亚州25家普通诊所的300名T2D患者的基线数据进行分析，这些数据来自“优化结构化监测以改善临床结局的普通实践研究”（GP - OSMOTIC）随机对照试验（2016年10月至2017年11月）。本研究使用了FreeStyle Libre Pro®传感器贴片。SES由相对社会经济劣势指数（IRSD）和教育程度定义。进行了单变量和多变量混合效应线性回归分析，对年龄、体重指数、饮食、运动和研究分组进行了控制。
167名（60.1%）参与者为男性，参与者的平均（标准差）年龄为61.0（9.7）岁，CGM的平均（标准差）使用时长为12.3（2.5）天。与第1个十分位数（最劣势）相比，第10个IRSD十分位数（最不劣势）的TIR高出15%（95%置信区间5，25；p = 0.003），HbA1c低0.6%（95%置信区间0.1，1；p = 0.03）。没有证据表明教育程度与TIR/HbA1c之间存在关联。
在GP - OSMOTIC队列中，使用HbA1c和TIR的补充测量方法，在地区层面测量的较高SES与更好地实现血糖目标相关。鉴于与HbA1c值相比，TIR可能更容易用于患者教育和自我管理支持，TIR中确定的社会梯度为临床医生和政策制定者解决T2D中的健康不平等问题提供了一个机会。
澳大利亚和新西兰临床试验注册中心试验编号ACTRN12616001372471，前瞻性，注册日期2016年10月4日。
