Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Diabet Med. 2021 Aug;38(8):e14500. doi: 10.1111/dme.14500. Epub 2021 Jan 7.
To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA not being measured.
A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA > 64 mmol/mol (8.0%) or HbA > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations.
Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs' use of a Noklus diabetes application reduced the risk of not having an HbA measurement performed.
Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA measurement in identified subgroups is warranted.
确定与 2 型糖尿病患者高血糖治疗过度和不足以及 HbA 未检测相关的个体和全科医生（GP）特征。
本横断面研究纳入了 282 名 GP 诊治的 10233 名 2 型糖尿病患者。过去 15 个月内 HbA 检测值的患者，如果年龄超过 75 岁且 HbA ＜53mmol/mol（7%）时处方磺脲类药物和/或胰岛素，或年龄在 65-75 岁之间且 HbA ＜48mmol/mol（6.5%）时处方磺脲类药物和/或胰岛素，则被归类为治疗过度。潜在治疗不足定义为年龄＜60 岁且 HbA＞64mmol/mol（8.0%）或 HbA＞69mmol/mol（8.5%），同时仅接受生活方式改变和/或单药治疗。我们使用多级二项和多项逻辑回归模型来检验关联。
总体而言，4.1%的患者存在治疗过度，7.8%的患者存在治疗不足，11%的患者未检测 HbA。与治疗过度相关的特征如下：糖尿病病程长、处方降压药物、心血管疾病和肾衰竭。潜在治疗不足与男性、非西方血统和低教育程度相关。未检测 HbA 的特征与男性、年龄＜50 岁和心血管疾病相关。GP 专科医师身份和 GP 使用 Noklus 糖尿病应用程序降低了未检测 HbA 的风险。
老年 2 型糖尿病患者的治疗过度相对较低。然而，在确定的亚组中，适当的治疗强度调整和定期检测 HbA 是必要的。
