澳门基层医疗环境中2型糖尿病患者管理的研究。

Study of type 2 diabetes management among patients in a Macau primary care setting.

作者信息

Wong In

机构信息

Health Bureau, Macau SAR Government, Macau, China.

出版信息

Fam Med Community Health. 2019 Sep 13;7(3):e000031. doi: 10.1136/fmch-2018-000031. eCollection 2019.

DOI:10.1136/fmch-2018-000031

PMID:32148710

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6910744/

Abstract

BACKGROUND

In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and is associated with premature death and disability and decreased quality of life. Moreover, this condition substantially increases healthcare expenditures.

OBJECTIVE

The primary objective was to assess the successful glycaemic control rates, blood pressure (BP) and cholesterol control rates in patients with T2DM in a Macau primary care setting. The secondary objective of this study was to assess the delay of insulin initiation in the Sao Lourence Health Center.

METHODS

Patients were stratified according to age (<65 years vs ≥65 years) and sex. Successful glycaemic control was defined as glycated haemoglobin (HbA1c) <7%. Successful cholesterol control was defined as a low-density lipoprotein cholesterol (LDL-C) level <2.6 mmol/L, and BP control was defined as BP <140/90 mm Hg.

RESULTS

Among the 2157 participants included in this study, 1046 (48.5%) patients had HbA1c <7%, 1209 (56.1%) patients had BP <140/90 mm Hg and 1244 (57.7%) patients had LDL-C <2.6 mmol/L. In conclusion, only 403 (18.7%) patients met the targets for all three measures. Of the 235 patients who were on insulin therapy, the mean (±SD) duration from T2DM diagnosis to insulin initiation was 7.47±6.52 years, the mean (±SD) duration from HbA1c not meeting the target (HbA1c ≥7% over 1 year and persistently) to insulin initiation was 3.34±3.66 years and the mean baseline HbA1c was 9.13%. Compared with patients with a longer duration (≥5 years) of HbA1c not meeting the target before insulin initiation, those who started insulin within 1 year of HbA1c not meeting the target had a better glycaemic control rate (40.7% vs 13%).

CONCLUSIONS

Nearly half of the patients at Sao Lourence Health Center, a primary care centre in Macau, met the glycaemic control target, but less than one-fifth of patients met all three targets for T2DM control. Moreover, there was a delay in insulin initiation for people with T2DM.

摘要

背景

在澳门的基层医疗环境中，2型糖尿病（T2DM）是第七大常见就诊原因。血糖控制不佳构成了一个主要的公共卫生问题，与过早死亡、残疾以及生活质量下降相关。此外，这种情况还大幅增加了医疗支出。

目的

主要目的是评估澳门基层医疗环境中T2DM患者的血糖控制成功率、血压（BP）和胆固醇控制率。本研究的次要目的是评估圣劳伦斯健康中心胰岛素起始治疗的延迟情况。

方法

患者根据年龄（<65岁与≥65岁）和性别进行分层。血糖控制成功定义为糖化血红蛋白（HbA1c）<7%。胆固醇控制成功定义为低密度脂蛋白胆固醇（LDL-C）水平<2.6 mmol/L，血压控制定义为血压<140/90 mmHg。

结果

在本研究纳入的2157名参与者中，1046名（48.5%）患者的HbA1c<7%，1209名（56.1%）患者的血压<140/90 mmHg，1244名（57.7%）患者的LDL-C<2.6 mmol/L。总之，只有403名（18.7%）患者达到了所有三项指标的目标。在235名接受胰岛素治疗的患者中，从T2DM诊断到开始胰岛素治疗的平均（±标准差）时间为7.47±6.52年，从HbA1c未达目标（HbA1c≥7%持续1年及以上）到开始胰岛素治疗的平均（±标准差）时间为3.34±3.66年，基线HbA1c平均为9.13%。与胰岛素起始治疗前HbA1c未达目标时间较长（≥5年）的患者相比，在HbA1c未达目标1年内开始胰岛素治疗的患者血糖控制率更高（40.7%对13%）。