Ambrož Martina, de Vries Sieta T, Hoogenberg Klaas, Denig Petra
Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Internal Medicine, Martini Hospital, Groningen, Netherlands.
Front Pharmacol. 2022 May 12;13:883103. doi: 10.3389/fphar.2022.883103. eCollection 2022.
We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends. We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication. We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 ( < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60-69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70-79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period ( < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend ( = 0.676). There were no differences in SBP thresholds between patients of different ages or sex. The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.
我们旨在评估2型糖尿病患者开始使用降糖和降压药物时糖化血红蛋白A1c（HbA1c）和收缩压（SBP）阈值的变化趋势，并评估年龄和性别对这些趋势的影响。我们使用了格罗宁根2型糖尿病治疗分析倡议（GIANTT）初级保健数据库。纳入了2015年至2020年间开始首次使用非胰岛素降糖药或任何降压药且在开始用药前120天内有HbA1c或SBP测量值的患者。我们使用针对潜在混杂因素进行调整的多水平回归分析，以评估历年、年龄或性别以及历年与年龄或性别的相互作用对开始用药时HbA1c和SBP阈值趋势的影响。在HbA1c和SBP阈值分析中，我们分别纳入了2671例和2128例患者。开始使用降糖药物时的总体平均HbA1c阈值从2015年的7.4%显著升至2020年的8.0%（<0.001），特别是在较年轻的年龄组中。与80岁及以上的患者相比，60 - 69岁的患者主要在早期以较低水平开始用药。60岁以下和70 - 79岁的患者开始用药的水平与80岁及以上的患者相似。在整个研究期间，女性开始用药的水平低于男性（<0.001）。开始使用降压药物时的平均SBP阈值在145至149 mmHg之间变化，无明显趋势（=0.676）。不同年龄或性别的患者在SBP阈值方面没有差异。较低年龄组开始使用降糖药物时HbA1c阈值的上升趋势出乎意料，需要进一步研究。男性开始使用降糖药物的时间似乎比女性更不及时。近年来，最高年龄组没有更高的阈值，最年轻年龄组也没有更低的阈值，这不符合与年龄相关的个性化糖尿病护理建议，需要卫生系统进行干预。
