Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Diabetes Care. 2022 Sep 1;45(9):2003-2011. doi: 10.2337/dc21-2283.
To assess the national prevalence of and trends in achieving current guideline-recommended treatment goals and pharmacotherapies for primary and secondary prevention of stroke among U.S. adults with type 2 diabetes (T2D).
We performed serial cross-sectional analyses in 4,834 adults aged ≥45 years with T2D who participated in the 2001-2018 National Health and Nutrition Examination Survey. With stratification by stroke history, we estimated the proportion of adults with T2D who achieved current guideline-recommended strategies for stroke prevention. Preventive strategies for stroke were benchmarked against diabetes care and cardiovascular risk reduction guidelines.
Overall in 2001-2018, among those without stroke history, the proportion who achieved primary stroke prevention strategies ranged from 8.4% (95% CI 6.8-10.1) for aspirin/clopidogrel treatment in those with a higher cardiovascular disease risk to 80.5% (78.8-82.2) for nonsmoking. Among those with stroke history, the proportion who achieved secondary stroke prevention strategies ranged from 11.8% (8.7-14.8) for weight control to 80.0% (74.9-84.9) for glycemic control. From 2001 to 2018, among those without stroke history, there was a significant increase in statin therapy (Ptrend < 0.0001), smoking abstinence (Ptrend = 0.01), and ACE inhibitor/angiotensin receptor blocker treatment for hypertension (Ptrend = 0.04) but a substantial decline in weight control (Ptrend < 0.001). Among those with stroke history, only statin therapy (Ptrend = 0.01) increased significantly over time.
During 2001-2018, the achievement of some current guideline-recommended strategies for stroke prevention among U.S. adults with T2D improved but remains a challenge overall. Efforts are needed to improve implementation of strategies for stroke prevention in this population.
评估美国患有 2 型糖尿病（T2D）的成年人中，目前指南推荐的用于卒中和二级预防的治疗目标和药物治疗在初级和二级预防中的全国流行率和趋势。
我们对参加了 2001-2018 年全国健康和营养调查的 4834 名年龄≥45 岁的 T2D 成年人进行了一系列的横断面分析。我们根据卒中史进行分层，估计了 T2D 成年人中达到当前指南推荐的卒中预防策略的比例。卒中预防策略与糖尿病治疗和心血管风险降低指南相比较。
总体而言，在 2001-2018 年期间，在没有卒中史的人群中，在心血管疾病风险较高的人群中，阿司匹林/氯吡格雷治疗达到一级卒中预防策略的比例从 8.4%（95%CI6.8-10.1）到不吸烟的比例达到 80.5%（78.8-82.2）；在有卒中史的人群中，控制体重达到二级卒中预防策略的比例从 11.8%（8.7-14.8）到血糖控制达到 80.0%（74.9-84.9）。从 2001 年到 2018 年，在没有卒中史的人群中，他汀类药物治疗（Ptrend<0.0001）、戒烟（Ptrend=0.01）和高血压的血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂治疗（Ptrend=0.04）显著增加，但体重控制明显下降（Ptrend<0.001）。在有卒中史的人群中，只有他汀类药物治疗（Ptrend=0.01）随着时间的推移显著增加。
在 2001-2018 年期间，美国患有 T2D 的成年人中，一些目前指南推荐的卒中预防策略的实施情况有所改善，但总体上仍面临挑战。需要努力改善该人群中卒中预防策略的实施。
