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改善血糖控制结果,无论是否存在心理健康障碍,在药剂师-内分泌学家糖尿病强化医疗管理(DIMM)“调优”诊所。

Improved Glycemic Control Outcomes Regardless of Mental Health Disorders in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) "Tune Up" Clinic.

机构信息

UC San Diego, La Jolla, CA, USA.

Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.

出版信息

Ann Pharmacother. 2020 Sep;54(9):858-865. doi: 10.1177/1060028020908856. Epub 2020 Feb 26.

Abstract

Previous studies show patients with type 2 diabetes (T2D) and a mental health (MH) disorder exhibit poorer glycemic control compared with those without. Compare mean change in glycosylated hemoglobin (A1C) after 6 months in the Diabetes Intense Medical Management (DIMM) "Tune Up" Clinic in patients with and without MH disorders. Retrospective cohort study in T2D patients, with A1C at baseline and 6 months, divided into subgroups of those with ≥1 MH diagnoses and without MH. Primary outcome was mean change in A1C from baseline to 6 months. Secondary outcomes were mean change in other metabolic parameters and proportion achieving A1C and related goals. Of 155 patients meeting inclusion criteria, 66 (42.6%) had at least 1 MH disorder (MH group) and 89 (57.4%) did not (non-MH group). Mean A1C, fasting blood glucose (FBG), and triglycerides (TG) change (improvement) did not differ significantly between MH and non-MH groups at 6 months (eg, A1C reduction: -2.1% [SD = 2.0] vs -2.3% [SD = 2.1]; P = 0.61, respectively). Percentage at A1C goal did not differ significantly between groups, though a higher percentage of the non-MH group achieved FBG and TG goals than the MH group. In 6 months, both groups in the DIMM clinic achieved a statistically significant mean A1C reduction (over 2%) with no statistical or clinical difference in the magnitude of change between groups. Patients with T2D benefitted from the DIMM model and personalized visits with a pharmacist regardless of having a MH disorder.

摘要

先前的研究表明,与没有精神健康障碍的 2 型糖尿病(T2D)患者相比,患有精神健康障碍的 T2D 患者血糖控制较差。比较患有和不患有精神健康障碍的患者在接受糖尿病强化医疗管理(DIMM)“调整”诊所治疗 6 个月后糖化血红蛋白(A1C)的平均变化。这是一项 T2D 患者的回顾性队列研究,患者基线和 6 个月时均有 A1C 值,分为有≥1 种精神健康诊断和没有精神健康的亚组。主要结局是从基线到 6 个月 A1C 的平均变化。次要结局是其他代谢参数的平均变化以及达到 A1C 和相关目标的比例。在符合纳入标准的 155 名患者中,有 66 名(42.6%)至少有一种精神健康障碍(MH 组),89 名(57.4%)没有(非-MH 组)。在 6 个月时,MH 组和非-MH 组的 A1C、空腹血糖(FBG)和三酰甘油(TG)的变化(改善)没有显著差异(例如,A1C 降低:-2.1%[标准差=2.0]与-2.3%[标准差=2.1];P=0.61)。两组之间达到 A1C 目标的比例没有显著差异,尽管非-MH 组达到 FBG 和 TG 目标的比例高于 MH 组。在 6 个月内,DIMM 诊所的两组患者均实现了 A1C 平均显著降低(超过 2%),两组之间的变化幅度没有统计学或临床差异。患有 T2D 的患者从 DIMM 模式和药剂师的个性化就诊中受益,无论是否患有精神健康障碍。

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