Cenexa. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina.
Medical Department, Sanofi, Buenos Aires, Argentina.
Diabetes Metab Res Rev. 2019 Sep;35(6):e3166. doi: 10.1002/dmrr.3166. Epub 2019 May 27.
To evaluate the relation between different serum lipid fractions and other known barriers to attain the HbA ≤ 7.0% (53 mmol/mol) target.
Data on 2719 patients with type 2 diabetes were collected from the five waves of the International Diabetes Mellitus Practice Study implemented in Argentina (2006 to 2012) including demographic/socioeconomic profile, clinical, metabolic (HbA and serum lipids) data, and treatment type and also, percentage of treatment goal attainment. Descriptive statistical analyses included ANOVA, χ test, and Fisher exact test and univariate and multivariate logistic regression analyses, which identified predictive factors for HbA ≤ 7% (53 mmol/mol).
The average age was 63 years, primary/secondary education, health insurance, 10-year type 2 diabetes duration, most associated with cardiovascular risk factors and some microvascular/macrovascular complications; 94.5% received antihyperglycaemic drugs. Percentage of people on target: HbA 51.2%, blood pressure 23.5%, total cholesterol 62.6%, low-density lipoprotein (LDL) cholesterol 38.9%, and triglycerides 61.1%. HbA on target depended markedly on treatment type: more of those treated with lifestyle changes and significantly fewer of those receiving insulin. Only 4.1% had all parameters simultaneously on target. Multivariate logistic regression analyses showed that achieving HbA ≤ 7.0% (53 mmol/mol) was associated with higher educational level, shorter diabetes duration, and having reached goals for LDL cholesterol and triglycerides, whereas opposite results were obtained with insulin treatment and longer diabetes duration.
High LDL cholesterol and triglyceride levels simultaneously potentiate development/progression of chronic complications, exerting this effect in the long term by decreasing β-cell mass/function, thereby making it more difficult to reach HbA values able to prevent complications.
评估不同血清脂质成分与其他已知障碍之间的关系，以达到 HbA1c≤7.0%（53mmol/mol）的目标。
从 2006 年至 2012 年在阿根廷实施的国际糖尿病实践研究的五个波次中收集了 2719 例 2 型糖尿病患者的数据，包括人口统计学/社会经济状况、临床、代谢（HbA 和血清脂质）数据以及治疗类型，还包括治疗目标达标率。采用方差分析、卡方检验和 Fisher 确切检验以及单变量和多变量逻辑回归分析，确定 HbA1c≤7%（53mmol/mol）的预测因素。
平均年龄为 63 岁，主要为小学/中学教育，有医疗保险，10 年 2 型糖尿病病程，与心血管危险因素和一些微血管/大血管并发症密切相关；94.5%接受了抗高血糖药物治疗。达标率：HbA1c 为 51.2%，血压为 23.5%，总胆固醇为 62.6%，低密度脂蛋白（LDL）胆固醇为 38.9%，三酰甘油为 61.1%。HbA1c 达标明显取决于治疗类型：接受生活方式改变治疗的患者达标率更高，而接受胰岛素治疗的患者达标率显著更低。仅有 4.1%的患者同时达到了所有参数的目标。多变量逻辑回归分析显示，达到 HbA1c≤7.0%（53mmol/mol）与较高的教育水平、较短的糖尿病病程以及达到 LDL 胆固醇和三酰甘油目标相关，而胰岛素治疗和较长的糖尿病病程则得到相反的结果。
高 LDL 胆固醇和三酰甘油水平同时加剧了慢性并发症的发生/进展，通过降低β细胞质量/功能，长期发挥这种作用，从而使 HbA 值更难以达到预防并发症的水平。
