新诊断 2 型糖尿病患者的降脂药物临床处方和治疗目标达标情况。
Clinician prescription of lipid-lowering drugs and achievement of treatment goals in patients with newly diagnosed type 2 diabetes mellitus.
机构信息
Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
出版信息
BMJ Open Diabetes Res Care. 2021 Feb;9(1). doi: 10.1136/bmjdrc-2020-001891.
INTRODUCTION
Lipid control is essential in type 2 diabetes mellitus (T2DM). The aim of this study is to investigate factors associated with lipid therapy adherence and achievement of goals in real-life setting among patients with recently diagnosed T2DM.
RESEARCH DESIGN AND METHODS
This is a longitudinal analysis in a center of comprehensive care for patients with diabetes. We include patients with T2DM, <5 years of diagnosis, without disabling complications (eg, amputation, myocardial infarct, stroke, proliferative retinopathy, glomerular filtration rate <60 mL/min/m) and completed 2-year follow-up. The comprehensive diabetes care model includes 9 interventions in 4 initial visits and annual evaluations. Endocrinologists follow the clinic's guideline and adapt therapy to reach risk-based treatment goal. The main outcome measures were the proportion of patients meeting low-density lipoprotein cholesterol (c-LDL) (<100 mg/dL) and triglycerides (<150 mg/dL) and proportion of patients taking statin, fibrate or combination at baseline, 3 months and annual evaluations.
RESULTS
We included 288 consecutive patients (54±9 years, 53.8% women), time since T2DM diagnosis 1 (0-5) year. Baseline, 10.8% patients were receiving statin therapy (46.5% moderate-intensity therapy and 4.6% high-intensity therapy), 8.3% fibrates and 4.2% combined treatment. The proportion of patients with combined treatment increased to 41.6% at 3 months, decreased to 20.8% at 1 year and increased to 38.9% at 2 years of evaluation. Patients receiving treatment met LDL and triglycerides goals at 3 months (17% vs 59.7%, relative ratio (RR)=0.89, 95% CI 0.71 to 1.12), at 1 year (17% vs 26.7%, RR=0.62, 95% CI 0.41 to 0.95) and at 2 years (17% vs 29.9%, RR=0.63, 95% CI 0.43 to 0.93). Main reasons for medication suspension: patient considered treatment was not important (37.5%) and other physician suspended treatment (31.3%).
CONCLUSION
88.2% of patients with T2DM required lipid-lowering drugs. Education for patients and physicians is critical to achieve and maintain diabetes goals.
TRIAL REGISTRATION NUMBER
NCT02836808.
简介
在 2 型糖尿病（T2DM）患者中，血脂控制至关重要。本研究旨在探讨在新诊断的 T2DM 患者的真实环境中，与血脂治疗依从性和目标达标相关的因素。
研究设计与方法
这是一项在糖尿病综合治疗中心进行的纵向分析。我们纳入了 T2DM 患者，病程<5 年，无失能性并发症（如截肢、心肌梗死、中风、增殖性视网膜病变、肾小球滤过率<60mL/min/m），且完成了 2 年随访。综合糖尿病护理模式包括在 4 次初始就诊和年度评估中进行 9 项干预措施。内分泌医生遵循诊所的指南并调整治疗以达到基于风险的治疗目标。主要结局指标是达到低密度脂蛋白胆固醇（c-LDL）<100mg/dL 和三酰甘油<150mg/dL 的患者比例，以及基线、3 个月和年度评估时服用他汀类药物、贝特类药物或联合治疗的患者比例。
结果
我们纳入了 288 例连续患者（54±9 岁，53.8%为女性），T2DM 诊断后时间为 1（0-5）年。基线时，10.8%的患者接受他汀类药物治疗（46.5%为中等强度治疗，4.6%为高强度治疗），8.3%接受贝特类药物治疗，4.2%接受联合治疗。接受联合治疗的患者比例在 3 个月时增加至 41.6%，在 1 年时降至 20.8%，在 2 年时增至 38.9%。接受治疗的患者在 3 个月（17% vs. 59.7%，相对比值（RR）=0.89，95%CI 0.71 至 1.12）、1 年（17% vs. 26.7%，RR=0.62，95%CI 0.41 至 0.95）和 2 年（17% vs. 29.9%，RR=0.63，95%CI 0.43 至 0.93）时达到 LDL 和三酰甘油目标。停药的主要原因：患者认为治疗不重要（37.5%）和其他医生停药（31.3%）。
结论
88.2%的 T2DM 患者需要降脂药物治疗。对患者和医生进行教育对于实现和维持糖尿病目标至关重要。
试验注册
NCT02836808。
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