From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2021 Feb;42(2):181-188. doi: 10.15537/smj.2021.2.25694.
To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality.
This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%.
Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, <0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, <0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure.
The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients' predictors may help to develop new therapeutic strategies to boost their glycemic status safely.
确定不受控制的糖尿病患者的社会人口统计学和临床预测因素，确定高风险和血糖控制受损的人群，制定更有效的策略来降低发病率和死亡率。
这是一项病例对照研究，共纳入了 8209 名患者，这些患者均来自沙特阿拉伯利雅得苏丹亲王军事医学城家庭和社区医学慢性病中心（CIC）的糖尿病登记处，入组时间为 2019 年 2 月至 2020 年 2 月。病例定义为 2 型难治性糖尿病患者，HbA1c 持续>9%，尽管在专家护理（CIC）下强化治疗至少 6 个月，但血糖控制仍不理想。对照组定义为 HbA1c≤9%的患者。采用多变量回归分析确定 HbA1c 持续>9%的患者的预测因素。
共有 1152 例病例和 4555 例对照纳入研究。难治性糖尿病患者更年轻（平均年龄：58.5 岁，标准差 [SD]：11.7 岁），女性比例更高（63.4%）。糖尿病病程（13.3 岁，SD：7.4，<0.001）和低密度脂蛋白（LDL）的平均水平（2.7，SD：0.91，<0.001）在难治性组中显著升高。最终模型的结果显示，年龄每增加 1 岁（比值比 [OR]：0.97，[95%置信区间 [CI]：0.96-0.98]）和体重指数（OR：0.97，[95%CI：0.95-0.99]），发生难治性糖尿病的几率分别降低 0.97 倍和 0.97 倍。而糖尿病病程每增加 1 年（OR：1.03，[95%CI：1.01-1.05]）、收缩压（OR：1.01，[95%CI：1.00-1.02]）和 LDL（OR：1.42，[95%CI：1.23-.62]），发生难治性糖尿病的几率分别比对照组增加 1.03 倍和 1.42 倍，且差异有统计学意义。以上结果均在性别、白蛋白肌酐、舒张压调整后得出。
本研究有助于确定糖尿病难治患者的预测因素。了解难治性患者的预测因素可能有助于制定新的治疗策略，以安全地改善他们的血糖状态。
