新西兰 2 型糖尿病患者中毛利人、太平洋岛民和欧洲裔在代谢达标方面的种族差异。

Ethnic differences in metabolic achievement between Māori, Pacific, and European New Zealanders with type 2 diabetes.

机构信息

Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele ST5 5BG, UK.

Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.

出版信息

Diabetes Res Clin Pract. 2022 Jul;189:109910. doi: 10.1016/j.diabres.2022.109910. Epub 2022 May 10.

DOI:10.1016/j.diabres.2022.109910

PMID:35537520

Abstract

AIMS

To compare variations in metabolic target achievement by ethnicity (Europeans, Māori and Pasifika) among patients with type 2 diabetes (T2DM) in Auckland, New Zealand (NZ) between 1994 and 2013.

METHODS

32,237 patients were enrolled. Adjusted marginal difference (European as reference) of systolic blood pressure (SBP), body mass index (BMI), HbA1c and total cholesterol, alongside the proportion achieving metabolic targets were estimated using multivariable mixed effect models at baseline, 1-, 2-, 3-, 4-, and 5-years, adjusted for covariates.

RESULTS

Compared with Europeans, Māori and Pasifika had continuously, significantly higher HbA1c (by 0.3% (+3.5 mmol/mol) and 0.6% (+6.8 mmol/mol) respectively and BMI (+1.5 and +0.3 kg/m respectively) but lower SBP (-1.8 and -3.4 mmHg respectively) and TG (-0.03 and -0.34 mmol/L respectively), and insignificantly TC (+0.004 and +0.01 respectively), by 5-years of follow-up. While 49% Europeans were within target HbA1c, this was achieved by only 30% Māori and 27% Pasifika. Conversely, 41% Europeans, 46% Māori and 59% Pasifika achieved the SBP target (all P < 0.0001).

CONCLUSIONS

Managing hyperglycemia appears to be more challenging than treating hypertension and dyslipidemia among Māori and Pasifika. New anti-hyperglycemia treatments, addressing health literacy, socioeconomic and any cultural barriers to management and self-management are urgently needed to reduce these disparities.

摘要

目的

比较 1994 年至 2013 年间新西兰奥克兰的 2 型糖尿病（T2DM）患者按族裔（欧洲人、毛利人和太平洋岛民）划分的代谢目标达标率的差异。

方法

共纳入 32237 例患者。使用多变量混合效应模型，根据协变量进行调整，在基线、1 年、2 年、3 年、4 年和 5 年时，对收缩压（SBP）、体重指数（BMI）、HbA1c 和总胆固醇的调整后的边缘差异（以欧洲人为参考）以及达到代谢目标的比例进行估计。

结果

与欧洲人相比，毛利人和太平洋岛民的 HbA1c 持续显著升高（分别升高 0.3%（+3.5mmol/mol）和 0.6%（+6.8mmol/mol），BMI 分别升高 1.5kg/m 和 0.3kg/m），SBP 降低（分别降低 1.8mmHg 和 3.4mmHg）和 TG 降低（分别降低 0.03mmol/L 和 0.34mmol/L），TC 略有升高（分别升高 0.004mmol/L 和 0.01mmol/L），随访 5 年后。虽然有 49%的欧洲人达到了 HbA1c 的目标值，但只有 30%的毛利人和 27%的太平洋岛民达到了目标值。相反，41%的欧洲人、46%的毛利人和 59%的太平洋岛民达到了 SBP 目标（均 P<0.0001）。