Davis Timothy M E, Colman Peter G, Hespe Charlotte, Heywood Sarah E, d'Emden Michael
Medical School, University of Western Australia, and Fremantle Hospital, Fremantle, Western Australia, Australia.
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2023 Oct;53(10):1796-1805. doi: 10.1111/imj.15929. Epub 2022 Oct 3.
Type 2 diabetes (T2D) is a well-recognised cardiovascular disease (CVD) risk factor, and recent guidelines for the management of T2D include consideration of CVD risk.
To assess whether contemporary clinical management of Australians with T2D is in accord with recent national and international guidelines.
This Australia-specific analysis of the CAPTURE study, a non-interventional, cross-sectional study included adults diagnosed with T2D ≥180 days prior to providing informed consent and visiting primary or specialist care. Main outcome measures were the use of blood glucose-lowering medications (BGLMs), BGLMs with proven cardiovascular benefits and other CVD medications, stratified by CVD status and care setting.
Of 824 Australian participants in the CAPTURE sample, 332 (40.3%) had CVD. Oral BGLMs were used by 83.9% of all participants, most commonly metformin (76.0%), dipeptidyl peptidase-4 inhibitors (28.8%), sodium-glucose cotransporter-2 inhibitors (SGLT2is; 21.8%) and sulfonylureas (21.7%). Insulin was used by 29.2% of participants. BGLMs with proven CV benefit were used by 22.6%; glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were less commonly used than SGLT2is in all CVD groups, but these drug classes were more often prescribed in specialist than primary care (SGLT2is 25.4 vs 20.7%, GLP-1 RAs 3.2 vs 0.8% respectively). Use of non-BGLMs for CVD risk reduction appeared consistent with guidelines.
Use of BGLMs with CVD benefits appears low in Australia, irrespective of CVD status. This likely reflects the delay in translation of clinical evidence into contemporary care and prescribing restrictions.
2型糖尿病（T2D）是一种公认的心血管疾病（CVD）风险因素，近期的T2D管理指南包括对CVD风险的考量。
评估澳大利亚T2D患者的当代临床管理是否符合近期的国家和国际指南。
这项针对澳大利亚的CAPTURE研究分析是一项非干预性横断面研究，纳入了在提供知情同意并就诊于初级或专科护理机构前已被诊断为T2D≥180天的成年人。主要结局指标是使用降糖药物（BGLMs）、具有已证实心血管益处的BGLMs和其他CVD药物，按CVD状态和护理机构分层。
在CAPTURE样本的824名澳大利亚参与者中，332名（40.3%）患有CVD。所有参与者中有83.9%使用口服BGLMs，最常用的是二甲双胍（76.0%）、二肽基肽酶-4抑制剂（28.8%）、钠-葡萄糖协同转运蛋白-2抑制剂（SGLT2is；21.8%）和磺脲类药物（21.7%）。29.2%的参与者使用胰岛素。具有已证实心血管益处的BGLMs使用率为22.6%；在所有CVD组中，胰高血糖素样肽-1受体激动剂（GLP-1 RAs）的使用频率低于SGLT2is，但这些药物类别在专科护理中比在初级护理中更常被处方（SGLT2is分别为25.4%对20.7%，GLP-1 RAs分别为3.2%对0.8%）。使用非BGLMs降低CVD风险的情况似乎符合指南。
在澳大利亚，无论CVD状态如何，具有CVD益处的BGLMs使用率似乎都很低。这可能反映了临床证据转化为当代护理的延迟以及处方限制。
