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挪威全科医疗中与 2 型糖尿病患者高血糖潜在过度和治疗不足以及 HbA1c 年度检测相关的因素。

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA in type 2 diabetes in norwegian general practice.

机构信息

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.

出版信息

Diabet Med. 2021 Aug;38(8):e14500. doi: 10.1111/dme.14500. Epub 2021 Jan 7.


DOI:10.1111/dme.14500
PMID:33354827
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8359382/
Abstract

AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

摘要

目的: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。

方法: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。

结果: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。

结论: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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3dba/8359382/3b9928c46f41/DME-38-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3dba/8359382/b1786eb11066/DME-38-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3dba/8359382/3b9928c46f41/DME-38-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3dba/8359382/b1786eb11066/DME-38-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3dba/8359382/3b9928c46f41/DME-38-0-g002.jpg

相似文献

[1]
Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA in type 2 diabetes in norwegian general practice.

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[2]
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引用本文的文献

[1]
Young-onset type 2 diabetes and associations with high disability rate, low educational level and immigrant background: a study from Norwegian general practice.

BMJ Open. 2025-9-4

[2]
Potential overtreatment in elderly patients with diabetes mellitus: Results from a cross-sectional study in German general practice.

Eur J Gen Pract. 2025-12

[3]
Quality assessment of glucose measurement with regard to epidemiology and clinical management of diabetes mellitus in Germany.

Front Mol Biosci. 2024-3-20

[4]
Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020.

Front Pharmacol. 2022-5-12

本文引用的文献

[1]
Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990-2017: A cohort study.

PLoS Med. 2020-5-15

[2]
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Ther Adv Endocrinol Metab. 2019-5-3

[3]
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Adv Ther. 2018-10-29

[4]
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Diabetologia. 2018-12

[5]
A1C Targets Should Be Personalized to Maximize Benefits While Limiting Risks.

Diabetes Care. 2018-6

[6]
Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014.

Scand J Prim Health Care. 2018-6

[7]
Use of Intensive Glycemic Management in Older Adults with Diabetes Mellitus.

J Am Geriatr Soc. 2018-4-10

[8]
Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies.

Diabetologia. 2018-2-7

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Type 2 diabetes in general practice in Norway 2005-2014: moderate improvements in risk factor control but still major gaps in complication screening.

BMJ Open Diabetes Res Care. 2017-11-8

[10]
Clinical inertia versus overtreatment in glycaemic management.

Lancet Diabetes Endocrinol. 2018-4

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