Clinical, Behavioral, and Outcomes Research Section, Joslin Diabetes Center, Boston, MA, USA.
Division of Cardiology, University of California Irvine, Irvine, CA, USA.
J Diabetes Complications. 2020 Aug;34(8):107591. doi: 10.1016/j.jdiacomp.2020.107591. Epub 2020 Apr 21.
To compare cardiovascular risk factor control in adults with diabetes participating in a national diabetes registry to those in the general population and to ascertain regional differences in diabetes care.
Adults with diagnosed diabetes in the Diabetes Collaborative Registry (DCR) were compared with those in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016; standardized mean difference (SMD) > 0.2 defined significance. Regional differences were assessed in the DCR cohort; p < .05 defined significance.
The DCR cohort was older (61 vs. 57 years, SMD = 0.38), more insured (99.7% vs. 91.0%, SMD = 0.42), and less ethnically diverse (83% non-Hispanic white vs. 76%, SMD = 0.30) compared with NHANES. The proportion of overweight/obesity, A1c < 7% (<53 mmol/mol), and BP < 140/90 were similar, but DCR participants had higher proportion with LDL < 2.59 mmol/L (61% vs. 41%, SMD = 0.39) and fewer tobacco users (17% vs. 32%, SMD = 0.35). Regionally, obesity, lack of glycaemic control, and tobacco use were highest in the Midwest, BP control was the lowest in the South, and LDL control was lowest in the Northeast.
Significant regional differences in diabetes care delivery and outcomes were identified using a national diabetes registry. Serial analyses of the DCR may supplement national evaluations to deepen our understanding of diabetes care in the US.
将参与国家糖尿病注册中心的成年糖尿病患者的心血管危险因素控制情况与普通人群进行比较，并确定糖尿病护理方面的地区差异。
将糖尿病合作注册中心（DCR）中的成年糖尿病患者与 2015 年至 2016 年期间的国家健康与营养检查调查（NHANES）中的患者进行比较；标准化均数差值（SMD）>0.2 定义为有显著差异。在 DCR 队列中评估区域差异；p<0.05 定义为有显著差异。
与 NHANES 相比，DCR 队列患者年龄更大（61 岁 vs. 57 岁，SMD=0.38）、参保率更高（99.7% vs. 91.0%，SMD=0.42）、种族多样性更低（83%非西班牙裔白人 vs. 76%，SMD=0.30）。超重/肥胖、A1c<7%（<53mmol/mol）和血压<140/90 的比例相似，但 DCR 参与者 LDL<2.59mmol/L（61% vs. 41%，SMD=0.39）的比例更高，且吸烟人数更少（17% vs. 32%，SMD=0.35）。从区域来看，中西部地区的肥胖、血糖控制不佳和吸烟率最高，南部地区的血压控制最差，东北部地区的 LDL 控制最差。
使用国家糖尿病注册中心发现了糖尿病护理提供和结果方面的显著地区差异。对 DCR 的连续分析可能会补充国家评估，以加深我们对美国糖尿病护理的理解。
