根据心血管风险评估的 2 型糖尿病患者的临床特征和护理质量：一项观察性、回顾性研究。
Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study.
机构信息
Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy.
San Donato Hospital, Arezzo, Italy.
出版信息
Cardiovasc Diabetol. 2021 Mar 6;20(1):59. doi: 10.1186/s12933-021-01251-4.
BACKGROUND
The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors.
METHODS
The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated.
RESULTS
Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased.
CONCLUSIONS
A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.
背景
欧洲心脏病学会（ESC）最近为糖尿病患者定义了心血管风险类别。本研究旨在根据 ESC 分类探讨 2 型糖尿病（T2D）患者按心血管风险组的分布，并描述护理质量指标，特别关注心血管危险因素。
方法
本研究基于参与 AMD 公告倡议的 258 家意大利糖尿病中心电子病历中提取的数据。根据心血管风险对 T2D 患者进行分层。评估一般描述性指标、中间结果指标、糖尿病和心血管危险因素的药物治疗强度/适当性、其他并发症的存在和整体护理质量。
结果
总体而言，评估了 473740 名 2 型糖尿病患者（78.5%处于极高心血管风险，20.9%处于高风险，0.6%处于中风险）。极高心血管风险的 T2D 患者中：26.4%有视网膜病变，39.5%有白蛋白尿，18.7%有先前的主要心血管事件，39.0%有器官损害，89.1%有三个或更多危险因素。随着心血管风险的增加，DPP4-i 的使用明显增加。促分泌素的处方也增加了，GLP1-RA 的处方趋于增加。SGLT2-i 的使用仍然有限，在极高心血管风险的患者中略高。整体护理质量，用 Q 评分来总结，随着心血管风险的增加而趋于降低。
结论
很大一部分 T2D 患者处于高或极高风险。降糖药物治疗的使用似乎没有充分考虑到其在降低心血管风险方面的潜在优势。需要采取多项措施来提高护理质量。
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