Patel Krishna K, Gomes Marilia B, Charbonnel Bernard, Chen Hungta, Cid-Ruzafa Javier, Fenici Peter, Hammar Niklas, Ji Linong, Kennedy Kevin F, Khunti Kamlesh, Kosiborod Mikhail, Pocock Stuart, Shestakova Marina V, Shimomura Iichiro, Surmont Filip, Watada Hirotaka, Arnold Suzanne V
Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
University of Missouri-Kansas City, Kansas City, Missouri, USA.
Diabetes Obes Metab. 2021 Jan;23(1):39-48. doi: 10.1111/dom.14180. Epub 2020 Sep 22.
To investigate global patterns of cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2D).
DISCOVER is an international, observational cohort study of patients with T2D beginning second-line glucose-lowering therapy. Risk factor management was examined among eligible patients (ie, those with the risk factor) at study baseline. Inter-country variability was estimated using median odds ratios (MORs).
Among 14 343 patients with T2D from 34 countries, the mean age was 57.4 ± 12.0 years and the median (interquartile range) duration of T2D was 4.2 (2.0-8.0) years; 11.8% had documented atherosclerotic cardiovascular disease (ASCVD). Among eligible patients, blood pressure was controlled in 67.5% (9284/13756), statins were prescribed in 43.7% (5775/13208), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were prescribed in 55.6% (5292/9512), aspirin was prescribed in 53.3% of those with established ASCVD (876/1645), and 84.4% (12 102/14343) were non-smoking. Only 21.5% of patients (3088/14343) had optimal risk factor management (defined as control of all eligible measures), with wide inter-country variability (10%-44%), even after adjusting for patient and site differences (MOR 1.47, 95% confidence interval 1.24-1.66).
Globally, comprehensive control of ASCVD risk factors is not being achieved in most patients, with wide variability among countries unaccounted for by patient and site differences. Better country-specific strategies are needed to implement comprehensive cardiovascular risk factor control consistently in patients with T2D to improve long-term outcomes.
调查2型糖尿病（T2D）患者心血管危险因素控制的全球模式。
DISCOVER是一项针对开始二线降糖治疗的T2D患者的国际观察性队列研究。在研究基线时，对符合条件的患者（即有该危险因素的患者）的危险因素管理情况进行了检查。使用中位数优势比（MOR）估计国家间的差异。
在来自34个国家的14343例T2D患者中，平均年龄为57.4±12.0岁，T2D的中位病程（四分位间距）为4.2（2.0 - 8.0）年；11.8%的患者有动脉粥样硬化性心血管疾病（ASCVD）的记录。在符合条件的患者中，67.5%（9284/13756）的血压得到控制，43.7%（5775/13208）的患者服用他汀类药物，55.6%（5292/9512）的患者服用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂，在已确诊ASCVD的患者中，53.3%（876/1645）的患者服用阿司匹林，84.4%（12102/14343）的患者不吸烟。只有21.5%的患者（3088/14343）实现了最佳危险因素管理（定义为所有符合条件的指标均得到控制），即使在调整了患者和研究地点差异后，国家间仍存在很大差异（10% - 44%）（MOR 1.47，95%置信区间1.24 - 1.66）。
在全球范围内，大多数患者未能实现对ASCVD危险因素的全面控制，国家间差异很大，且患者和研究地点差异无法解释这种差异。需要制定更好的针对特定国家的策略，以便在T2D患者中持续实施全面的心血管危险因素控制，从而改善长期预后。
