UC San Diego, La Jolla, CA, USA.
Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
Ann Pharmacother. 2020 Sep;54(9):858-865. doi: 10.1177/1060028020908856. Epub 2020 Feb 26.
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.
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。