Yang Aimin, Wu Hongjiang, Lau Eric S H, Ma Ronald C W, Kong Alice P S, So Wing Yee, Luk Andrea O Y, Chan Juliana C N, Chow Elaine
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
Diabetes Care. 2020 Dec;43(12):2967-2974. doi: 10.2337/dc20-0260. Epub 2020 Oct 12.
There has been a shift toward new classes of glucose-lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs use, glycemic control, and SH rate among patients with diabetes in Hong Kong, which introduced a territory-wide, team-based diabetes care model since 2000.
Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLD classes, mean hemoglobin A (HbA) levels, and SH rates in 763,809 patients with diabetes aged ≥20 years between 2002 and 2016.
Between 2002 and 2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase 4 inhibitors (DPP-4is) (0.01% in 2007 to 8.3%). The proportion of patients with HbA of 6.0-7.0% (42-53 mmol/mol) increased from 28.6% to 43.4%, while the SH rate declined from 4.2/100 person-years to 1.3/100 person-years. The main improvement in HbA occurred between 2007 and 2014, decreasing from mean (SD) 7.6% (1.6) (59.5 [19.0] mmol/mol) to 7.2% (1.7) (54.8 [18.9] mmol/mol) ( < 0.001). The 20-44 years age-group had the highest proportion of HbA ≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).
In this 15-year survey, the modest but important improvement in HbA since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylureas, and modest rise in DPP-4i use. Persistently poor glycemic control and underuse of GLDs in the youngest group calls for targeted action.
在过去十年中，降糖药物（GLDs）已转向新的类别，但在以往的调查中，血糖控制或因严重低血糖（SH）导致的住院率并无改善。我们研究了香港糖尿病患者使用GLDs、血糖控制和SH发生率的趋势，香港自2000年起引入了全地区基于团队的糖尿病护理模式。
利用香港糖尿病监测数据库中的人群数据，我们估算了2002年至2016年间763809名年龄≥20岁的糖尿病患者中GLD类别的年龄和性别标准化比例、平均血红蛋白A（HbA）水平以及SH发生率。
2002年至2016年间，磺脲类药物的使用比例下降（从62.9%降至35.3%），而二甲双胍（从48.4%增至61.4%）和二肽基肽酶4抑制剂（DPP - 4is）（2007年为0.01%至8.3%）的使用比例上升。HbA为6.0 - 7.0%（42 - 53 mmol/mol）的患者比例从28.6%增至43.4%，而SH发生率从4.2/100人年降至1.3/100人年。HbA的主要改善发生在2007年至2014年间，从平均（标准差）7.6%（1.6）（59.5 [19.0] mmol/mol）降至7.2%（1.7）（54.8 [18.9] mmol/mol）（P < 0.001）。20 - 44岁年龄组HbA≥9%（75 mmol/mol）的比例最高，且未使用GLDs的比例不断上升（从2.0%升至7.7%）。
在这项为期15年的调查中，自2007年以来HbA虽有适度但重要的改善，这与糖尿病服务改革、二甲双胍使用增加、磺脲类药物使用减少以及DPP - 4i使用适度增加相吻合。最年轻组血糖控制持续不佳且GLDs使用不足，需要采取针对性行动。
