1 型糖尿病患者的心血管风险管理：使用三种指南的表现。
Cardiovascular risk management in people with type 1 diabetes: performance using three guidelines.
机构信息
Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
Diabeter, Center for Focussed Diabetes Care and Research, Rotterdam, The Netherlands.
出版信息
BMJ Open Diabetes Res Care. 2022 Jul;10(4). doi: 10.1136/bmjdrc-2022-002765.
INTRODUCTION
Cardiovascular disease (CVD) is the leading cause of mortality in individuals with type 1 diabetes mellitus (T1DM). Cardiovascular risk management is therefore essential in the management of individuals with T1DM. This study describes the performance of lipid and blood pressure management in individuals with T1DM using three guidelines.
RESEARCH DESIGN AND METHODS
Individuals ≥18 years with T1DM, treated with insulin for ≥1 year, visiting Diabeter or the University Medical Center Groningen between January 1, 2018 and December 31, 2018, were included. Lipid and blood pressure management were examined using the Dutch, American Diabetes Association (ADA) and National Institute for Health and Care Excellence (NICE) guidelines. Concordance of recommended and prescribed lipid-lowering (LLM) or antihypertensive medication (AHM) was assessed per guideline and 10-year age groups. Achievement of treatment targets was assessed for those prescribed medication.
RESULTS
A total of 1855 individuals with T1DM were included. LLM and AHM was prescribed in 19% and 17%, respectively. In individuals recommended LLM, this was prescribed in 22%-46% according to Dutch, ADA or NICE guideline recommendations. For individuals recommended AHM, this was prescribed in 52%-75%. Recommended and actual prescription of LLM and AHM increased over age for all three guidelines. However, discordance between treatment recommendation and medication prescribed was higher in younger, compared with older, age groups. Low-density lipoprotein-cholesterol targets were achieved by 50% (without CVD) and 31% (with CVD) of those prescribed LLM. The blood pressure target was achieved by 46% of those prescribed AHM.
CONCLUSION
This study suggests that there is undertreatment of lipid and blood pressure according to guideline recommendations, particularly in younger age groups. Treatment targets are not met by most individuals prescribed medication, while guidelines recommendations differ considerably. We recommend to investigate the factors influencing undertreatment of lipid and blood pressure management in individuals with T1DM.
简介
心血管疾病（CVD）是 1 型糖尿病（T1DM）患者死亡的主要原因。因此，心血管风险管理对于 T1DM 患者的管理至关重要。本研究使用三种指南描述了 T1DM 患者的血脂和血压管理表现。
研究设计和方法
纳入 2018 年 1 月 1 日至 2018 年 12 月 31 日期间在 Diabeter 或格罗宁根大学医学中心就诊、患有 T1DM 且至少接受了 1 年胰岛素治疗的年龄≥18 岁的个体。使用荷兰、美国糖尿病协会（ADA）和英国国家卫生与保健优化研究所（NICE）指南评估血脂和血压管理情况。根据指南和 10 岁年龄组评估推荐和规定的降脂（LLM）或降压药物（AHM）的一致性。评估了那些服用药物的个体的治疗目标是否达到。
结果
共纳入 1855 例 T1DM 患者。分别有 19%和 17%的患者处方了 LLM 和 AHM。在推荐使用 LLM 的患者中，根据荷兰、ADA 或 NICE 指南的建议，处方的比例为 22%-46%。对于推荐使用 AHM 的患者，处方的比例为 52%-75%。对于所有三种指南，随着年龄的增长，推荐和实际处方的 LLM 和 AHM 均有所增加。然而，与老年组相比，年轻组的治疗建议与药物处方之间的差异更大。建议使用 LLM 的患者中，有 50%（无 CVD）和 31%（有 CVD）达到了低密度脂蛋白胆固醇目标。建议使用 AHM 的患者中，有 46%达到了血压目标。
结论
本研究表明，根据指南建议，尤其是在年轻患者中，存在降脂和降压治疗不足的情况。大多数服用药物的患者未达到治疗目标，而指南建议存在较大差异。我们建议调查影响 T1DM 患者血脂和血压管理治疗不足的因素。
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