微量白蛋白尿教育药物和优化 (MEMO) 研究：2 型糖尿病高危个体的多因素干预 4 年随访。

The Microalbuminuria Education Medication and Optimisation (MEMO) study: 4 years follow-up of multifactorial intervention in high-risk individuals with type 2 diabetes.

机构信息

Diabetes Research Centre, University of Leicester, Leicester, UK.

Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.

出版信息

Diabet Med. 2020 Feb;37(2):286-297. doi: 10.1111/dme.14134. Epub 2019 Sep 23.

DOI:10.1111/dme.14134

PMID:31505051

Abstract

AIMS

The Microalbuminuria Education Medication and Optimisation (MEMO) study, revealed improved cardiovascular risk and glycaemic control with 18 months of intensive multifactorial intervention in high-risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer-term outcomes at 4-year follow-up in these participants.

METHODS

Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi-ethnic population in Leicestershire, UK. The intervention group (n = 95) received multifactorial intervention with self-management education, and the control group (n = 94) received usual care. The primary outcome was change in HbA , and secondary outcomes were blood pressure (BP), cholesterol, microalbuminuria, estimated GFR, cardiovascular risk scores and major adverse cardiovascular events.

RESULTS

Some 130 participants (68.7%), mean (sd) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4 years of follow-up. Mean change [95% confidence intervals (CI)] in HbA over 4 years was greater with intensive intervention compared with control (-3 mmol/mol, 95% CI -4.95,-1.11; -0.4%, 95% CI -0.67,-0.15; P = 0.002). Significant improvements over the 4 years were also seen in systolic BP (-7.3 mmHg, 95% CI -11.1, -3.5; P < 0.001), diastolic BP (-2.9 mmHg, 95% CI -5.4, -0.3; P = 0.026), cholesterol (-0.3 mmol/l, 95% CI -0.52,-0.12; P = 0.002), and 10-year coronary heart disease (-5.3, 95% CI -8.2,-2.3; P < 0.001) and stroke risk (-4.4, 95% CI -7.5, -1.3; P < 0.001).

CONCLUSION

Multifactorial intervention with structured diabetes self-management education compared with usual diabetes care has benefits for cardio-metabolic risk factor profile. There was no increase in severe hypoglycaemia and cardiovascular mortality despite intensive glycaemic control, although the study was not powered to assess these outcomes.

摘要

目的

微量白蛋白尿教育药物和优化（MEMO）研究表明，在高危 2 型糖尿病患者中进行 18 个月的强化多因素干预可改善心血管风险和血糖控制，而严重低血糖并无增加。我们的目的是在这些参与者的 4 年随访中评估更长期的结果。

方法

从英国莱斯特郡的一个多民族人群中招募了 189 名患有 2 型糖尿病和微量白蛋白尿的患者。干预组（n=95）接受了多因素干预，包括自我管理教育，对照组（n=94）接受了常规护理。主要结局是 HbA 的变化，次要结局是血压（BP）、胆固醇、微量白蛋白尿、估计肾小球滤过率（eGFR）、心血管风险评分和主要不良心血管事件。

结果

130 名参与者（68.7%）完成了 4 年的随访，平均（标准差）年龄 60.8（10.4）岁，糖尿病病程 11.5（9.7）年。与对照组相比，强化干预 4 年内 HbA 的平均变化（95%置信区间）更大（-3mmol/mol，95%CI-4.95，-1.11；-0.4%，95%CI-0.67，-0.15；P=0.002）。4 年内还观察到收缩压（-7.3mmHg，95%CI-11.1，-3.5；P<0.001）、舒张压（-2.9mmHg，95%CI-5.4，-0.3；P=0.026）、胆固醇（-0.3mmol/l，95%CI-0.52，-0.12；P=0.002）和 10 年冠心病（-5.3，95%CI-8.2，-2.3；P<0.001）和卒中风险（-4.4，95%CI-7.5，-1.3；P<0.001）的显著改善。