Goh C C, Koh K H, Goh Scp, Koh Yle, Tan N C
B Pharm, SingHealth Polyclinics 167, Jalan Bukit Merah, Tower 5 #15-10, Singapore 150167 Email:
M.Med (Fam Med), MRCS., SingHealth Polyclinics.
Malays Fam Physician. 2018 Aug 31;13(2):10-18. eCollection 2018.
Achieving optimal glycated hemoglobin (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) in patients mitigates macro- and micro-vascular complications, which is the key treatment goal in managing type 2 diabetes mellitus (T2DM). This study aimed to determine the proportion of patients in an urban community with T2DM and the above modifiable conditions attaining triple vascular treatment goals based on current practice guidelines.
A questionnaire was distributed to adult Asian patients with dyslipidemia at two primary care clinics (polyclinics) in northeastern Singapore. The demographic and clinical data for this sub-population with both T2DM and dyslipidemia were collated with laboratory and treatment information retrieved from their electronic health records. The combined data was then analyzed to determine the proportion of patients who attained triple treatment goals, and logistic regression analysis was used to identify factors associated with this outcome.
665 eligible patients [60.5% female, 30.5% Chinese, 35% Malays, and 34.4% Indians] with a mean age of 60.6 years were recruited. Of these patients, 71% achieved LDL-C ≤2.6 mmol/L, 70.4% had BP <l40/90 mmHg, and 40.9% attained HbAlc ≤7%. Overall, 22% achieved the triple treatment goals for glycemia, BP, and LDL-C control. The major determinants were the number of diabetic medications and intensity of statin therapy.
Eight in ten patients with T2DM failed to achieve concurrent glycemic, BP, and LDL-C treatment goals, subjecting them to risks of vascular complications. Primary healthcare professionals can mitigate these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and BP control.
使患者达到最佳糖化血红蛋白（HbA1c）、血压（BP）和低密度脂蛋白胆固醇（LDL-C）水平可减轻大血管和微血管并发症，这是2型糖尿病（T2DM）管理的关键治疗目标。本研究旨在根据当前实践指南，确定城市社区中患有T2DM且具备上述可改变条件的患者达到三重血管治疗目标的比例。
在新加坡东北部的两家基层医疗诊所（综合诊所）向成年亚洲血脂异常患者发放问卷。将该患有T2DM和血脂异常的亚人群的人口统计学和临床数据与从其电子健康记录中检索到的实验室和治疗信息进行整理。然后对合并数据进行分析，以确定达到三重治疗目标的患者比例，并使用逻辑回归分析来确定与该结果相关的因素。
招募了665名符合条件的患者[女性占60.5%，华人占30.5%，马来人占35%，印度人占34.4%]，平均年龄为60.6岁。在这些患者中，71%的患者LDL-C≤2.6 mmol/L，70.4%的患者血压<140/90 mmHg，40.9%的患者HbAlc≤7%。总体而言，22% 的患者实现了血糖、血压和LDL-C控制的三重治疗目标。主要决定因素是糖尿病药物的数量和他汀类药物治疗的强度。
十分之八的T2DM患者未能同时实现血糖、血压和LDL-C治疗目标，使他们面临血管并发症的风险。基层医疗专业人员可以通过优化治疗来降低这些风险，以最大限度地控制血糖、血脂异常和血压。
