Hankosky Emily R, Schapiro David, Gunn Karli B, Lubelczyk Elizabeth B, Mitroi Jessica, Nelson David R
Value, Evidence and Outcomes (VEO)-Diabetes, Eli Lilly and Company, Indianapolis, IN, USA.
Diabetes Ther. 2023 Jun;14(6):967-975. doi: 10.1007/s13300-023-01399-0. Epub 2023 Apr 17.
Glycated hemoglobin A1c (HbA1c) is an important measure to assess glycemic control and predict diabetes complications. However, there is limited information on trends in HbA1c among people with diabetes (PwDs) who use insulin. The aim of this study was to describe trends in HbA1c among PwDs who use insulin by diabetes type and insulin regimen.
A retrospective analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES, 2009-2020). PwDs were classified into three cohorts: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus using mealtime insulin (T2DM-MTI), and type 2 diabetes mellitus (T2DM) using basal-only insulin (T2DM basal-only). Trends in HbA1c over time were assessed using regression analysis after adjusting for age, gender, and race/ethnicity.
Mean HbA1c values aggregated over 2009-2020 were 8.0% (T1DM), 8.6% (T2DM-MTI), and 8.6% (T2DM basal-only). The American Diabetes Association-recommended target of HbA1c of < 7% was achieved by 25.2% of people in the T1DM and T2DM-MTI groups each and by 12.3% of people in the T2DM basal-only group. Over time, an upward trend was observed in the percentage of people achieving HbA1c < 7% in the T2DM basal-only group. The percentage of PwDs achieving individualized HbA1c targets was 27.0%, 12.4%, and 16.1% for the T1DM, T2DM-MTI, and T2DM basal-only groups, respectively.
Our study using NHANES data suggests that approximately 25% of PwDs achieve glycemic targets. This study highlights the need for improved therapies to better manage glycemic targets in PwDs.
糖化血红蛋白A1c（HbA1c）是评估血糖控制和预测糖尿病并发症的一项重要指标。然而，关于使用胰岛素的糖尿病患者（PwDs）的HbA1c变化趋势的信息有限。本研究的目的是按糖尿病类型和胰岛素治疗方案描述使用胰岛素的PwDs的HbA1c变化趋势。
使用来自美国国家健康与营养检查调查（NHANES，2009 - 2020年）的数据进行回顾性分析。PwDs被分为三个队列：1型糖尿病（T1DM）、使用餐时胰岛素的2型糖尿病（T2DM - MTI）以及仅使用基础胰岛素的2型糖尿病（T2DM基础胰岛素组）。在调整年龄、性别和种族/民族因素后，使用回归分析评估HbA1c随时间的变化趋势。
2009 - 2020年汇总的平均HbA1c值分别为：T1DM组8.0%，T2DM - MTI组8.6%，T2DM基础胰岛素组8.6%。美国糖尿病协会推荐的HbA1c目标值<7%在T1DM组和T2DM - MTI组中分别有25.2%的人达到，在T2DM基础胰岛素组中有12.3%的人达到。随着时间推移，T2DM基础胰岛素组中达到HbA1c<7%的人群百分比呈上升趋势。达到个体化HbA1c目标的PwDs百分比在T1DM组、T2DM - MTI组和T2DM基础胰岛素组中分别为27.0%、12.4%和16.1%。
我们使用NHANES数据的研究表明，约25%的PwDs实现了血糖目标。本研究强调需要改进治疗方法以更好地管理PwDs的血糖目标。
