Qaddoumi Mohammad, Al-Khamis Yousuf, Channanath Arshad, Tuomilehto Jaakko, Badawi Dalia
Dasman Diabetes Institute, Kuwait City, Kuwait.
Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait.
Front Endocrinol (Lausanne). 2019 Jun 26;10:412. doi: 10.3389/fendo.2019.00412. eCollection 2019.
To evaluate metabolic control in patients with type 2 diabetes at Dasman Diabetes Institute (DDI, Kuwait), a specialist diabetes clinic and research center, and to investigate its association with patient demographics and clinical characteristics. Data from 963 patients with type 2 diabetes were retrospectively collected from the Knowledge Based Health Records maintained at DDI for patients who attended DDI during 2011-2014. The collected data included patient demographics, clinical characteristics, and anti-diabetic medications. Student's -test was used to evaluate the differences in mean values between poor and good glycemic control groups. Categorical variables were assessed using chi-square analysis with Fisher's exact test for small data sets. The patients' mean age was 53.0 ± 9.5 years with equal number of males and females. Females (34.4 ± 7.2 kg/m) had a higher mean body mass index than males (32.1 ± 6.4 kg/m). The mean fasting blood glucose and HbA1c levels were 9.6 ± 3.8 mmol/L and 8.5 ± 1.8%, respectively. Dyslipidemia (46%) and hypertension (40%) were the most common comorbidities, whereas nephropathy (36%) and neuropathy (35%) were the most common diabetic complications. The most commonly used anti-diabetic medication was metformin (55%). Factors significantly associated with poor glycemic control (HbA1c level ≥ 7%) included insulin use; neuropathy or foot ulcers as diabetic complications; and elevated systolic blood pressure and total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and fasting blood glucose levels. Factors significantly associated with good glycemic control included metformin use and elevated high-density lipoprotein cholesterol level. The proportion of patients with good glycemic control (HbA1c level < 7%) was 29.5%. A large proportion of the patients with poor glycemic control were only administered monotherapy drugs, and two-thirds of the patients were obese. Further, the American Diabetes Association (ADA) recommendations for blood pressure and LDL cholesterol level were met (62 and 63%, respectively) by follow-up year 4. The therapeutic management of type 2 diabetes in Kuwait is suboptimal. Therapeutic strategies should ensure better adherence to ADA guidelines, evaluate the high obesity rates, and adherence to lifestyle recommendations by patients, and continually promote diabetes education and self-empowerment.
为评估科威特达斯曼糖尿病研究所（DDI，一家专业糖尿病诊所及研究中心）2型糖尿病患者的代谢控制情况，并调查其与患者人口统计学特征及临床特征的关联。我们从DDI维护的基于知识的健康记录中，回顾性收集了2011年至2014年期间就诊于DDI的963例2型糖尿病患者的数据。收集的数据包括患者人口统计学特征、临床特征及抗糖尿病药物使用情况。采用学生t检验评估血糖控制不佳组与良好组之间的均值差异。分类变量采用卡方分析，并对小数据集使用Fisher精确检验进行评估。患者的平均年龄为53.0±9.5岁，男女数量相等。女性（34.4±7.2kg/m²）的平均体重指数高于男性（32.1±6.4kg/m²）。平均空腹血糖和糖化血红蛋白（HbA1c）水平分别为9.6±3.8mmol/L和8.5±1.8%。血脂异常（46%）和高血压（40%）是最常见的合并症，而肾病（36%）和神经病变（35%）是最常见的糖尿病并发症。最常用的抗糖尿病药物是二甲双胍（55%）。与血糖控制不佳（HbA1c水平≥7%）显著相关的因素包括使用胰岛素；患有神经病变或足部溃疡等糖尿病并发症；收缩压升高、总胆固醇、低密度脂蛋白（LDL）胆固醇、甘油三酯及空腹血糖水平升高。与血糖控制良好显著相关的因素包括使用二甲双胍及高密度脂蛋白胆固醇水平升高。血糖控制良好（HbA1c水平<7%）的患者比例为29.5%。血糖控制不佳的患者中很大一部分仅接受单药治疗，且三分之二的患者肥胖。此外，到随访第4年时，分别有62%和63%的患者达到了美国糖尿病协会（ADA）关于血压和LDL胆固醇水平的建议。科威特2型糖尿病的治疗管理并不理想。治疗策略应确保更好地遵循ADA指南，评估高肥胖率以及患者对生活方式建议的依从性，并持续促进糖尿病教育和自我管理。
