澳大利亚普通实践中 2 型糖尿病患者遵医嘱 HbA1c 检测频率与更好结局：一项 5 年回顾性队列研究。

Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice.

机构信息

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

出版信息

BMJ Qual Saf. 2021 Sep;30(9):706-714. doi: 10.1136/bmjqs-2020-012026. Epub 2021 Feb 4.

DOI:10.1136/bmjqs-2020-012026

PMID:33542066

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8380884/

Abstract

BACKGROUND

Clinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence.

OBJECTIVE

This study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD).

METHODS

This 5-year retrospective cohort study (July 2013-June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient's adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%-66%) and high (>66%). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes.

RESULTS

In the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed.

CONCLUSION

Better adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.

摘要

背景

临床实践指南强调了定期监测糖化血红蛋白 A1c（HbA1c）对于 2 型糖尿病患者的作用，大多数建议每 6 个月检测一次。尽管如此，很少有深入研究评估推荐的检测频率对患者的临床影响，以支持指南遵循的意义。

目的

本研究旨在检查患者结局与澳大利亚指南（HbA1c 控制良好的患者每 6 个月检测一次，HbA1c 控制不佳的患者每 3 个月检测一次）推荐的检测频率之间的关联。主要和次要结局是 HbA1c 值的纵向变化以及缺血性心脏病（IHD）和慢性肾脏病（CKD）的发生。

方法

这是一项为期 5 年的回顾性队列研究（2013 年 7 月至 2018 年 6 月），评估了在大约 250 家澳大利亚普通诊所收集的数据中确定的 2 型糖尿病患者亚组中的 HbA1c 检测频率。该研究包括 2013 年年龄≥18 岁且在研究期间有研究实践中 HbA1c 检测记录的患者。每位患者的依从率定义为按照澳大利亚指南推荐的检测间隔进行的 HbA1c 检测比例。根据依从率，将依从水平分为低（≤33%）、中（34%-66%）和高（>66%）。采用广义加性混合模型检查了遵守推荐的 HbA1c 检测频率与患者结局之间的关联。

结果

在 6424 例糖尿病患者中，总体中位数 HbA1c 检测频率为每年 1.6 次，依从率为 50%。低依从率患者的估计 HbA1c 水平逐渐升高或仍未得到充分控制，而高依从率患者的 HbA1c 值随时间推移保持控制或改善。高依从率患者发生 CKD 的风险明显低于低依从率患者（OR：0.42，95%CI 0.18 至 0.99）。未观察到 IHD 与遵守推荐的 HbA1c 频率之间存在关联。