真实世界心力衰竭人群中糖尿病和糖尿病前期的患病率及治疗情况：一项单中心横断面研究。

Prevalence and treatment of diabetes and pre-diabetes in a real-world heart failure population: a single-centre cross-sectional study.

机构信息

Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden

Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.

出版信息

Open Heart. 2022 Dec;9(2). doi: 10.1136/openhrt-2022-002133.

DOI:10.1136/openhrt-2022-002133

PMID:36600650

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9748948/

Abstract

AIMS

The aim of this study was to investigate a real-world heart failure (HF) cohort regarding (1) prevalence of known diabetes mellitus (DM), undiagnosed DM and pre-diabetes, (2) if hf treatment differs depending on glycaemic status and (3) if treatment of DM differs depending on HF phenotype.

METHODS

All patients who had received a diagnosis of HF at Umeå University Hospital between 2010 and 2019 were identified and data were extracted from patient files according to a prespecified protocol containing parameters for clinical characteristics, including echocardiogram results, comorbidities, fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) values. Patients' HF phenotype was determined using the latest available echocardiogram. The number of patients with previous DM diagnosis was assessed. Patients without a previous diagnosis of DM were classified as non-DM, pre-diabetes or probable DM according to FPG and HbA1c levels using WHO criteria.

RESULTS

In total, 2326 patients (59% male, mean age 76±13 years) with HF and at least one echocardiogram were assessed. Of these, 617 (27%) patients had a previous diagnosis of DM. Of the 1709 patients without a previous diagnosis of DM, 1092 (67%) patients had either an FPG or HbA1c recorded, of which 441 (41%) met criteria for pre-diabetes and 97 (9%) met criteria for probable diabetes, corresponding to 19% and 4% of the entire cohort, respectively. Patients with HF and diabetes were more often treated with diuretics and beta blockers compared with non-DM patients (64% vs 42%, p<0.001 and 88% vs 83%, p<0.001, respectively). There was no difference in DM treatment between HF phenotypes.

CONCLUSIONS

DM and pre-diabetes are common in this HF population with 50% of patients having either known DM, probable DM or pre-diabetes. Patients with HF and DM are more often treated with common HF medications. HF phenotype did not affect choice of DM therapy.

摘要

目的

本研究旨在调查一个真实世界的心力衰竭（HF）患者队列，以研究以下内容：（1）已知糖尿病（DM）、未诊断 DM 和糖尿病前期的患病率；（2）HF 治疗是否因血糖状况而异；（3）DM 治疗是否因 HF 表型而异。

方法

从 2010 年至 2019 年在于默奥大学医院被诊断为 HF 的所有患者中确定研究对象，并根据包含临床特征参数的预设方案从病历中提取数据，包括超声心动图结果、合并症、空腹血糖（FPG）和糖化血红蛋白（HbA1c）值。使用最新的超声心动图确定患者的 HF 表型。评估有既往 DM 诊断的患者人数。无既往 DM 诊断的患者根据 FPG 和 HbA1c 水平，按照世界卫生组织（WHO）标准分为非 DM、糖尿病前期或可能 DM。

结果

共评估了 2326 例 HF 且至少有一次超声心动图的患者（59%为男性，平均年龄 76±13 岁）。其中，617 例（27%）患者有既往 DM 诊断。在 1709 例无既往 DM 诊断的患者中，有 1092 例（67%）记录了 FPG 或 HbA1c 值，其中 441 例（41%）符合糖尿病前期标准，97 例（9%）符合可能糖尿病标准，分别占整个队列的 19%和 4%。与非 DM 患者相比，HF 合并糖尿病的患者更常接受利尿剂和β受体阻滞剂治疗（64% vs 42%，p<0.001；88% vs 83%，p<0.001）。HF 表型之间的 DM 治疗无差异。