Caballero A Enrique, Nordstrom Beth L, Liao Birong, Fan Ludi, Zhang Nan, Fraeman Kathy H, Perez-Nieves Magaly
Harvard Medical School, Boston, MA, USA.
Evidera, Inc, Waltham, MA 02451, USA.
J Diabetes Complications. 2021 Nov;35(11):108011. doi: 10.1016/j.jdiacomp.2021.108011. Epub 2021 Jul 30.
To identify which individual-, physician-, and the healthcare system-related factors can predict individualized hemoglobin A1c (HbA1c) targets and the likelihood of reaching those targets after initial insulin therapy over a two-year follow-up period.
Real-world data, including baseline characteristics of people with type 2 diabetes mellitus (T2DM), psychosocial data, and diabetes medication use, collected from the Multinational Observational Study Assessing Insulin Use (MOSA1c) study in 18 countries were analyzed.
Overall, 225 of 1194 people with T2DM (18.8%) who received initial insulin therapy for ≥3 months reached HbA1c targets at two-year follow-up; most were likely to be White (64.9%) and perceptions of their relationship with physicians were less positive than those who did not reach HbA1c targets. Higher baseline HbA1c (>8%) was the strongest predictor of being assigned an HbA1c target >7% (odds ratio [OR] 6.06, 95% confidence interval [CI] 3.97, 9.26). A smaller difference between baseline and target HbA1c levels was the strongest predictor of reaching an HbA1c target at two-year follow-up (large vs small difference, OR 0.28, 95% CI 0.17, 0.47).
Several factors were significantly associated with establishing individualized HbA1c targets and reaching these targets. A small proportion of people with T2DM on insulin therapy reached their HbA1c target. Personalized management of glycemic targets necessitates the adoption of multi-factorial strategies, as several factors could influence an individual's glycemic outcome. CLINICALTRIALS.
NCT01400971.
确定在两年随访期内，哪些个体、医生和医疗系统相关因素能够预测个体化糖化血红蛋白（HbA1c）目标以及初始胰岛素治疗后达到这些目标的可能性。
分析了从18个国家的评估胰岛素使用的多国观察性研究（MOSA1c）中收集的真实世界数据，包括2型糖尿病（T2DM）患者的基线特征、社会心理数据和糖尿病药物使用情况。
总体而言，1194例接受初始胰岛素治疗≥3个月的T2DM患者中，225例（18.8%）在两年随访时达到了HbA1c目标；大多数可能为白人（64.9%），且他们对与医生关系的看法不如未达到HbA1c目标的患者积极。较高的基线HbA1c（>8%）是被分配HbA1c目标>7%的最强预测因素（优势比[OR]6.06，95%置信区间[CI]3.97，9.26）。基线和目标HbA1c水平之间较小的差异是两年随访时达到HbA1c目标的最强预测因素（差异大与差异小相比，OR 0.28，95%CI 0.17，0.47）。
几个因素与设定个体化HbA1c目标并达到这些目标显著相关。接受胰岛素治疗的T2DM患者中，一小部分达到了HbA1c目标。血糖目标的个性化管理需要采用多因素策略，因为几个因素可能影响个体的血糖结果。临床试验。
NCT01400971。
